右侧颈丛与硬膜外麻醉减轻胆系手术牵涉痛的临床应用

目的:探讨右侧颈丛与硬膜外麻醉减轻胆系手术牵涉痛的临床应用效果。方法:收治胆囊择期手术患者400例,随机分为3组。A组采用1%利多卡因+0.5%罗哌卡因,首次剂量7～9ml,使麻醉平面控制在T4以下、L1以上。用6.5针头行右侧颈丛常规穿刺,注入1.0%利多卡因或0.375%罗哌卡因4ml,再退针行颈浅丛阻滞注药5～6ml;B组100例,在手术部位消毒时经静脉滴入芬太尼1～2μg/kg+咪唑安定0.1～0.15mg/kg;C组100例,在B组基础上手术进腹后采用2%利多卡因行腹腔内封闭。结果:A组BP、P较B、C两组平稳,3组的SPO2各时期在吸氧的情况下无明显区别,A组较B、C两组的疼痛反应明显减轻。结论:右侧颈丛与硬膜外麻醉可以有效减轻胆系手术牵涉痛,是一种较好的麻醉方法。

Objective：explore the right side of the cervical plexus and epidural anesthesia reduce the biliary surgery involves pain clinical application effect. Methods： 400 cases collected in our hospital from March 2011 to January 2012 the gallbladder elective surgery patients were randomly divided into three groups. In group A, 1% lidocaine 0. 5% ropivacaine dose of 7 -9ml for the first time, so that the anesthesia control in T4 the following, more than the L1.6.5 needies line the right side of the cervical plexus conventional puncture, injection of 4 ml of 1.0% lidocaine or 0. 375% ropivacaine passed on needle, superficial cervical plexus block injection of 5 - 6ml ; B group of lO0 cases in surgery parts of the disinfection by intravenous instillation the the fentanyl 1 2μg/kg ＋ midolam 0. 1 -0. 15mg/kg; 100cases of group C,group B on the basis of u- sing 2% lidocaine intra - abdominal surgery into the abdomen closed. The results： A group of BP, P compared with B, and C were stable, no significant difference between groups A, B,C SPO2 each period in the case of oxygen, group A than B, and C were pain was significantly reduced. Conclusion： The right side of the cervical plexus and epidural anesthesia can effectively reduce the referred pain of biliary tract surgery is a better anesthetic methods worthy of clinical appli- cation.