Spinocath导管连续蛛网膜下隙阻滞在老年妇科肿瘤手术麻醉中的实践的论文.docVIP

　　Spinocath导管连续蛛网膜下隙阻滞在老年妇科肿瘤手术麻醉中的实践的论文 【摘要】 目的 比较连续腰麻(csa)、腰-硬联合麻醉(csea)用于高龄妇科肿瘤手术患者的临床效应。方法 择期妇科恶性肿瘤实施开腹广泛全子宫切除并盆腔淋巴清扫手术的患者60例，年龄70～78岁，asaⅱ～ ⅳ 级，分为csa组(ⅰ组，n=30)和csea(ⅱ组，n=30)。csea组于l3～4间隙蛛网膜下腔注入0.5% 布比卡因5.5～7.5 mg，硬膜外用药一次2% 利多卡因2～6 ml，麻醉平面不够或时间超过60 min再追加2% 利多卡因2～4 ml。csa组采用spinocath导管针，于l3～4间隙穿刺，蛛网膜下腔置管2 cm，首次剂量0.5% 布比卡因5.0～6.5 mg，手术90 min后追加3.0～5.0 mg。比较两组的阻滞平面、镇痛效果、肌松程度，循环变化及术后并发症等情况。结果 以上两组在麻醉阻滞平面、镇痛效果、肌松程度。循环变化情况差异有统计学意义(plt;0.05)。结论 spinocath连续腰麻用于老年患者，特别是施行妇科盆腔手术时，麻醉效果满意，肌松完全，对呼吸、循环系统干扰小，麻醉并发症少，是一种理想的麻醉方法。 【关键词】 连续腰麻;妇科肿瘤;spinocath导管 application of spinocath catheter continuous spinal anesthesia in the surgery of elderly gynecological malignant tumor 　　fang man-jing，luo li-bing，chang jun，et al.maternal and child health hospital of nanshan，shenzhen 518052，china 　　[abstract] objective to pare the clinical effect of continuous spinal anesthesia(csa)，spinal and epidural anesthesia(csea)for elderly patients alignant tumor.method for selective implementation of the abdominal gynecological malignancies extensive hysterectomy and pelvic lymph node dissection in patients alignant tumors.methods 90 cases of gynecologic malignancies because of the implementation of extensive abdominal hysterectomy and pelvic lymph node dissection patients ly divided into tg，a 2% lidocaine epidural medication 2～6 ml，anesthesia is not enough，or more than 60 min and then didan additional 2% lidocaine 2～4 ml.csa group ，the first dose of 0.5% bupivacaine g，an additional g after 90 minutes of surgery.pared the block plane，analgesic effect，degree of muscle relaxation，circulation changes and postoperative plications and so on in tuscle relaxation，circulation changes in tplementation of gynecological pelvic surgery，has the effect of anesthesia uscle relaxation is plete，the disturbance to respiratory and circulatory is small，plications of anesthesia is feethod of anesthesia. 　　[key in。选择l3～4椎间隙，a 组用spinocath穿刺针行蛛网膜下腔穿刺置管，置管长度为1.5～2.5 cm。首次剂量0.5%布比卡因5.0～6.5 mg，分次快速注入蛛网膜下腔。根据体位及局麻药用量调节麻醉平面，手术