腰麻硬膜外联合麻醉用于直肠癌根治术和子宫全切术的观察

Comparison of Combined Spinal Epidural Anesthesia with Epidural Anesthesia in Lower Abdominal Surgery

目的 :观察腰麻 (SA)、硬膜外 (EA)联合麻醉 (CSEA)局麻药用量、麻醉效果、副作用及术后并发症 ,并探讨CSEA时追加EA局麻药的时机。方法 :170例ASAⅠ～Ⅱ级择期手术患者 ,随机分为A、B、C3组。A组 (n =50 )单用EA ;B组 (n =78)SA实施后常规追加EA (利多卡因 2～ 4mg/kg) ;C组 (n=4 2 )为SA实施后必要时追加EA。结果 :B组麻醉效果满意 ,其满意度高于C组 (P <0 .0 5) ,A组与C组无差别。硬膜外用药A组 (12 .2 7mg/kg)高于B组 (7.14mg/kg)和C组 (8.2 1mg/kg) (P <0 .0 5) ,B组和C组的术后头痛发生率高于A组。结论 :CSEA效果确切 ,局麻药用量小 ,除头痛发生率较EA高外 ,其它副作用及并发症发生率低 ,且SA实施后加连续小剂量硬膜外麻醉更为理想。

Objective:To compare anesthesia effect.volume of local anesthetic from epidural blockade and complication of combined spinal epidural anesthesia(CSEA) with epidural anesthesia,to evaluate time of administering local anesthetic of epidural after spinal anesthesia.Method:170 patients(ASA.Ⅰ～Ⅱ)were randomly devided into group A.group B and group C.Group A(n=50) was given epidural anesthesia;Group B(n=78) was performed continuous epidural blockade after administering local anesthetic of Spinal anesthesia;Group C (n=42) was given local anesthetic of spinal blockade reduced.Blood pressure.pulse and spo 2 were monitoring.Anesthesia offect.volume of local anesthetic and complication were observed during and ofter Operation.Result:anesthesia effect of group B was most excellent in three groups.Compared to group B and group C.volume of epidural anesthestic of group A (12.27mg/kg)was significant higher(P<0.05).Parameter of hemodynamics had no difference statisticaly.The incidence of headache in group B and group C was higher than that of group A(P<0.05).Conclusion:CSEA has an important clinic value.