硬膜外阻滞复合雷米芬太尼-丙泊酚应用于宫颈癌根治术的效果观察

Effect of epidural anesthesia combined with remifentanil-propofol in radicalhysterectomy for cervical cancer

目的探讨硬膜外麻醉复合雷米芬太尼-丙泊酚应用于宫颈癌根治术的麻醉效果。方法56例ASAI～Ⅱ行宫颈癌根治术患者随机分成雷米芬太尼组（R组，n=28）和杜氟合剂组（D组，n=28），R组在硬膜外麻醉后缓慢静注丙泊酚1mg／kg后用丙泊酚2．0mg／kg．h＋雷米芬太尼0．1ug／kg．min靶控输注，D组用杜冷丁50mg＋氟哌啶2．5mg后，靶控输注丙泊酚2．0mg／kg．h。记录5个时间点的血压和心率；记录术中体动反应及术毕呼之睁眼时间，恶心呕吐等评级及患者满意度。结果①两组在给药后SBP、DBP、HR较给药前降低（P〈0．05〉，切皮时有增高，但D组升高较R组明显（P〈0．05〉；②术后D组眩晕、头痛、躁动及患者满意度与R组相比，差异有统计学意义（P〈0．05〉。结论硬膜外复合雷米芬太尼适合在宫颈癌根治术中使用，与复合杜氟合剂相比较，在苏醒程度上更为优良，患者更为舒适。

Objective To explore clinical effect of epidural anesthesia combined with remifentanil-propofol undergoing radical hysterectomy in patients with cervical cancer. Methods 56 ASA I-II cases with radical hysterectomy were randomly divided into two groups, Remifentanil group （group R, n = 28）, target controlled infusion （TCI） propofo1 2.0 mg/kg.h concentration ＋ Remifentanil 0.1 ug/kg.Min after lmg/kg propofol injected slowly by the intravenous route, and Dolantin- droperidol mixture group （group D, n = 28）, TCI propofol 2.0 mg/ kg.h concentration after Dolantin50mg ＋ droperidol 2.5mg injected slowly by the intravenous route. All patients were oxygenated by nasal cannula. The HR and BP were recorded at five time points respectively. Body reaction of interoperation, the time of opening eyes, nausea and vomiting rating and patient satisfaction of post operation were observed respeetively. Results ① In both groups, patients＇ HR dropped after drug intravenous injection and increased when operation was started （P〈 0.05 ）, in which HR in group D reflected increasing more obvious than that in group R （P〈0.05）.② Comparing with group R, the dizziness, headaches, restlessness, and the degree of satisfaction of group D were statistically difference in the postoperative period （P〈 0.05）. Conclusion Epidural anesthesia combined with remifentanil undergoing radical hysterectomy could provide an even better solution on patient＇ s regaining consciousness and the degree of comfort.