腰硬联合麻醉复合镇静剂量丙泊酚与腰硬联合麻醉用于腹腔镜全子宫切除术的临床效果对比

Comparative study on spinal-epidural anesthesia combined with sedative doses of propofol versus spinal-epidural anesthesia in total hysterectomy

目的比较腰硬联合麻醉复合镇静剂量丙泊酚与腰硬联合麻醉在腹腔镜全子宫切除术中的临床疗效。方法选择2011—07—2013-07我院收治的行全子宫切除的患者96例，随机分为观察组和对照组，每组各48例。对照组给予腰硬联合麻醉，观察组给予腰硬联合麻醉复合镇静剂量丙泊酚麻醉。术中对患者呼吸循环功能指标PETCO2、HR、MAP及SpO2进行监测，比较两组患者的麻醉效果和不良反应发生情况。结果①观察组麻醉优良率显著高于对照组（95．8％vs66．7％，P〈0．01）。②观察组患者在气腹后15min（T3）和气腹后30min（T4）时HR较对照组降低（P〈0．05）。观察组患者在气腹后30min（T4）时MAP较对照组降低（P〈0．05）。③观察组在牵拉反射、低血压及心动过缓方面的发生率均明显低于对照组（P〈0．01）。结论在全子宫切除手术中，腰硬联合麻醉复合镇静剂量丙泊酚相比较腰硬联合麻醉而言，具有麻醉效果好、不良反应少等特点，是一种可行的麻醉方案。

Objective To compare the clinical efficacy of spinal-epidural anesthesia combined with sedative doses of propofol versus spinal-epidural anesthesia for total hysterectomy. Methods Totally 96 patients undergoing total hysterectomy in our hospital from July 2011 to July 2013 were randomly divided into observation group and control group （n = 48 in each group）. The patients were given spi- nal-epidural anesthesia in control group, and spinal-epidural anesthesia combined with sedative doses of propofol in observation group. Respiratory and circulatory function indicators, such as PETCO2, HR, MAP and SpO2 were monitored during operation. And the effects of anesthesia and adverse events were compared between two groups. Results ①The excellent rate in observation group was signifi- cantly higher than that in control group （95.8% vs 66.7 %, P 〈 0.01 ）. ②Compared with control group, HR decreased in observation group at 15 min（ T3 ） and 30 rain after pneumoperitoneum （ T4 ） （ P 〈 0.05 ） ;MAP in observation group decreased at T4 （ P 〈 0.05 ）. ③ The incidences of stretch reflex, hypotension and bradycardia in observation group were lower than those in control group after surgery. Conclusion Compared with spinal-epidural anesthesia, spinal-epidural anesthesia combined with sedative doses of propofol has good anesthetic effects and less adverse reactions in total hysterectomy. And it is a viable anesthetic solution in clinic.