宫腔镜手术的麻醉

Anesthesia for hysteroscopy

目的 通过对 797例宫腔镜手术患者的麻醉情况作回顾性分析 ,对宫腔镜手术的麻醉方法进行总结和展望。方法 收集 1995年 1月至 2 0 0 0年 12月间行宫腔镜手术患者 797例 ,包括 :①宫腔镜下通液、取环、刮宫 (包括诊断性刮宫 ) ;②宫腔镜下宫腔粘连分解 ;③宫腔镜下子宫黏膜下肌瘤电切割术、内膜息肉切除或摘除术、赘生物切除或摘除术 ,均住院治疗。主要的麻醉方法包括鞍麻、连续硬膜外麻醉、脊 硬联合麻醉 (CSEA)、静脉麻醉。比较硬膜外麻醉和CSEA及异丙酚和异丙酚联合芬太尼麻醉的麻醉效能和对呼吸、循环功能的影响。结果 自 1995年来 ,宫腔镜下子宫黏膜下肌瘤电切割术、内膜息肉切除或摘除术、赘生物切除或摘除术逐年增多 ;而宫腔镜下通液、取环、刮宫术 (包括诊断性刮宫 )逐年减少 ,宫腔镜下宫腔粘连分解术也呈下降趋势。宫腔镜手术的麻醉以静脉麻醉和硬膜外麻醉为主 ,1998年以前静脉麻醉较多 ,以后硬膜外麻醉有所增加。在麻醉效能方面 ,异丙酚联合芬太尼麻醉减少了异丙酚的总用量 (P <0 .0 1) ,缩短了注药后睫毛反射消失时间 (P <0 .0 5 ) ;CSEA注入局麻药后 ,麻醉平面到达T8的时间明显缩短 (P <0 .0 1) ,术后肌松恢复较快 (P <0 .0 5 )。这两种联合麻醉与以往麻醉方法相比 ,均对呼吸、循环功能?

Objective To analyze retrospectively the methods of anesthesia for hysteroscpy. Methods Data of 797 hospitalizied patients under gone hysteroscopy were collected which consisted of 1). fluid infusion of Fallopian tubes、removal of IUD and therapeutic and diagnostic curettage; 2). Division of intrauterine adhesion (IUA); 3). resection of submucous myomectomy or cervical polyps or neoplasm enucleation. The main anesthetic methods included spinal anesthesia、epidural anesthesia、CSEA and intravenous anesthesia. Comparsion of the anesthetic effect and effects on patients's respiratory and circulatory statusby epidural anesthesia and CSEA with intravenous single propofol and propofol combining with fentany were made during the period of 1995.1～2000.12. Results Since 1995, the submucous myomectomy or cervical polyps or neoplasm enucleation by hysteroscopy were increased while the fluid infusion of Fallopian tubes、removal of IUD、curettage and the division of intrauterine adhesion(IUA)by hysteroscopy were decreased. Anesthesia for hysteroscopy is mainly by epidural anesthyesia and intravenous anesthesia. The intravenous anesthesia was practised more before 1998, then the use of epidural anesthesia increased gradually. The quantity of Propofol used in group Propofol combining with Fentanyl was less than that in group Propofol singly ( P <0.01) and the disappearance duration of eyelash reflex was shorter( P <0.05), as well as the time of anesthetic level up to T 8 ( P <0.01) after injecting local narcotics and the recovery of muscle relaxation was also move rapid ( P <0.05) in CSEA than that in epidural anesthesia. Furthermore, comparing with other anesthetic methods, CSEA and propofol combining with fentanyl had least effect on patient's respiratory and circulatory function.Conclusion With the improvement of the anesthesia manipulation and monitor technique, the anesthesia for hysteroscopy will best be chosen the simpler manipulating、 good effect and easily control methods with short term narcotics.