腰硬联合麻醉复合小剂量丙泊酚静脉麻醉在子宫全切术中的应用

The application of combined spinal and epidural anesthesia combined with small dose of propofol intravenous anesthesia in total hysterectomy

目的观察腰硬联合麻醉复合小剂量丙泊酚静脉麻醉应用于子宫全切术的可行性和安全性,为患者提供更加舒适的麻醉方案。方法选择择期行子宫全切术的患者80例,根据麻醉方法随机分为治疗组和对照组各40例,治疗组予以腰硬联合麻醉复合小剂量丙泊酚静脉麻醉,对照组行腰硬联合麻醉。术中均常规监测生命体征,并记录入室后麻醉前(T1)、麻醉后15min(T2)、切皮后30min(T3)、术毕时(T4)各时间点MAP、HR、SpO2,观察术中不良反应的发生率,评价术毕改良清醒镇静(MOAA/S)评分及麻醉效果。结果治疗组麻醉效果优率为95.0%,高于对照组的62.5%(P<0.05)。与T1时比较,治疗组T2、T3时HR、MAP均降低(P<0.05),对照组T2时MAP降低(P<0.05);与对照组比较,治疗组T3时HR、MAP均降低(P<0.05),2组患者术中均未发生严重呼吸抑制。治疗组不良反应发生率明显少于对照组(P<0.05)。2组MOAA/S评分比较差异无统计学意义(P>0.05)。结论腰硬联合麻醉复合小剂量丙泊酚静脉麻醉可安全应用于子宫全切术中,且麻醉效果优于腰硬联合麻醉。

Objective To observe the feasibility and safety of the combined spinal and epidural anesthesia（ CSEA） combined with small dose of propofol intravenous anesthesia in total hysterectomy. Methods 80 cases of patients undergoing total hysterectomy were randomly divided into treatment group and control group,each of 40 cases. The treatment group received CSEA combined with small dose of propofol intravenous anesthesia,while the control group only received CSEA. MAP,HR and SpO 2 were recorded at before anesthesia （ T1 ） ,15 minutes after anesthesia （ T2 ） ,30 minutes after operation （ T3 ） ,at the end of the operation （ T4 ） . The incidence of intraoperative adverse events,the modified observer＇s assessment of alertness/sedation （ MOAA/S） scores and anesthetic effect of satisfaction of the operation were evaluated. Results The anesthetic effect excellent rate （ 95. 0% ） of the treatment group was better than that of the control group（ 62. 5% ） （ P〈0. 05） . Compared with T1 , MAP and HR at T2 and T3 are lower in the treatment group （ P〈0. 05） ,and they are lower at only T2 in the control group （ P〈0. 05） ; Compared with the control group,MAP and HR at T3 in the treatment group are lower （ P〈0. 05） . There was not serious respiratory depression during surgery in both groups. The adverse reaction rate in the treatment group is less than in the control group （ P〈0. 05） . There was not significant difference in MOAA / S score between the 2 groups（ P〈0. 05） . Conclusion CSEA combined with small dose of propofol intravenous anesthesia can be securely used in total hysterectomy,and the anesthetic effect of which is better than only CSEA.