杜氟合剂给药时机对腹腔镜手术硬膜外麻醉效果影响.docVIP

杜氟合剂给药时机对腹腔镜手术硬膜外麻醉效果影响 　 作者：姚延丽，李 键，赵俊昌，缪凤芳 【摘要】 目的：探讨杜氟合剂给药时机对腹腔镜手术硬膜外麻醉效果的影响。方法：将120例腹腔镜手术患者随机分为A、B两组，每组60例，A组于硬膜外注入试验量6min后，再从静脉注入杜氟合剂(哌替啶1mg/kg,氟哌啶0.1mg／kg)；B组硬膜外注入同样剂量的药物20min后，再从静脉注入与A组同样剂量的杜氟合剂（即切皮时给药）。结果：A组56例患者气腹时无痛苦，无躁动；4例轻微肩部牵扯痛，但均顺利完成手术。B组12例患者肩部牵扯痛，加用辅助用药完成手术，11例患者痛苦难忍、气腹困难，被迫中转全麻。A组麻醉效果明显优于B组（P＜0.01）。结论：采用连续硬膜外阻滞麻醉下行腹腔镜手术时，杜氟合剂在硬膜外注入试验量6min静脉给药(即在麻醉测出平面后给药)可达到较好的麻醉效果。 【关键词】 杜氟合剂；腹腔镜术；麻醉，硬膜外 【Abstract】 Ｏbjective:To explore the clinical effect of different administration juncture of pethidine and droperidol mixture during epidural anaesthesia of laparoscopic surgery.Methods:One hundred and twenty patients were divided into two groups randomly.The pethidine and droperidol mixture(pethidine 1mg/kg,droperidol 0.1mg/kg) was intravenous injected 6 minutes after applying trial dose accompanied with epidural anaesthesia in group A.The delay time was 20 minutes in group B.Results:There is no pain and restlessness in the 56 cases of group A.Only 4 cases of patients felt light pain of shoulder,but all procedures were successfully performed.12 cases of patients have pain of shoulder in group B,and procedures were performed with adjunctive medicine.11 cases of patients felt suffering and were converted to general anaesthesia.The effect of anaesthesia in group A was better than that of group B(P＜0.01).Conclusions:To inject pethidine and droperidol mixture 6 minutes after applying trial dose accompanied of epidural anaesthesia can reach satisfactory effect in laparoscopic surgery. 【Key words】 Pethidine and droperidol mixture;Laparoscopy;Anaesthesia,epidural 腹腔镜手术多在全麻下进行，近年来连续硬膜外阻滞麻醉行腹腔镜手术的报道越来越多［1］。2001年12月～2006年10月，我们在硬膜外麻醉下行腹腔镜手术120例，发现杜氟合剂辅助给药时机影响麻醉效果，现总结报道如下。 1 资料与方法 1.1 临床资料 选择我院2001年12月至2006年10月采用硬膜外麻醉的120例腹腔镜手术患者，ASA分级Ⅰ～Ⅱ级，其中男75例，女45例，17～67岁，平均35.6岁。其中腹腔镜胆囊手术27例，阑尾切除术83例，精索静脉结扎10例。将120例患者随机分为A、B两组，每组60例。两组在年龄、性别、体重及手术类型均无统计学上的差别。 1.2 麻醉方法 术前常规禁食6h，禁水4h，术前30min肌注阿托品0.01mg/kg，鲁米那钠2mg/kg。全程监测心电图、平均动脉压、心率和血氧饱和度。两组均先行硬膜外穿刺置管，注入试验量，待平面测出后常规注入全量。A组于硬膜外注入试验量6m