脊麻-硬膜外联合麻醉用于肥胖患者妇科手术的临床观察

Clinical Observation of Combined Spinal-Epidural Anesthesia applied in Obese Patients Undergoing Gynecological Surgery

目的 评价脊麻 硬膜外联合麻醉 (CSEA)用于肥胖妇科手术的麻醉效果。方法 4 0例肥胖妇科病人随机分为CSEA组和EA组。CESA组用 0 75 %布比卡因 1 5～ 2 0ml,如果麻醉平面不够 ,硬膜外追加 2 %利多卡因3～ 5ml。EA组硬膜外注入 0 2 %地卡因 + 1 6%利多卡因。分别观察两组病人麻醉前后、手术前后的MAP、HR、EKG、SpO2 变化 ,以及两组病人的麻醉起效时间、术中静脉用药量、术者对麻醉的评价等。结果 ①CSEA组麻醉前后、手术前后病人的BP无显著变化 (P >0 0 5 ) ,而EA组麻醉后SBP、DBP、MAP较麻醉前显著下降 (P <0 0 5 )。②两组相比 ,麻醉起效时间、术中静脉用药量以及术者对麻醉的满意程度有极显著差异 (P <0 0 5 )。结论 CSEA是肥胖病人妇科手术的理想麻醉方法之一。

Objective\ To evaluate the clinical effect of combined spinal epidural anesthesia (CSEA) in the obese patients urdergoing gynecological surgery. Methods\ Forty obese patients were randomly divided into two groups,CSEA Group and Epidural Anesthesia(EA) Group. 1.5～2.0ml of 0.75 % bupivacaine was used in CSEA and, in case of necessity, 3～5 ml of 2 % lidocaine was added epidurally. In EA Group, 0.2% Dicaine+1.6% Lidocaine was injected epidurally. The changes in the two groups relating to MAP, HR, SpO\-2 and EKG were observed at four different time points, i.e., pre anesthetically, post anesthetically, pre operatively and post operatively. The initial effective time of anesthesia, dosage of intravenous administration and surgeons' assessment were recorded. Results\ No differences were found in BP at four time points (P>0.05) in CSEA Group, but S\-\{BP\}, D\-\{BP\}, and MAP in EA Group more remarkably decreased pre anesthetically than post anesthetically (P<0.01). The differences in the initial time of anesthesia, dosage of intravenous medication and surgeons' satisfaction were significant between the two groups. Conclusion\ CSEA can serve as an ideal procedure for the obese patients undergoing gynecologic surgery.