腰硬联合麻醉在阴式子宫全切术中应用.docVIP

腰硬联合麻醉在阴式子宫全切术中应用 　【摘要】 目的 评价腰硬联合麻醉在子宫全切术中的应用效果。方法 随机选择43例因子宫肌瘤行子宫全切术患者，年龄29～53岁，体重48～74 kg，ASA Ⅰ～Ⅱ级，随机分为两组。对照组（单纯硬膜外麻醉）21例，治疗组（腰硬联合麻醉）22例，术中均常规监测生命体征、ECG、SpO2以及术中患者牵拉反应情况，观察麻醉效果。结果 两组患者术中血流动力学较平稳，HR、SpO2、ECG差别无统计学意义。麻醉效果方面，对照组优11例，良6例，差4例，优良率为80.95 ％；治疗组：优19例，良3例，差0例，优良率为100 ％；两组优良率对比差异有统计学意义(Plt;0.05)；对照组部分患者术中有内脏牵拉反应；治疗组患者术中未见腹肌紧张、恶心呕吐及疼痛反应，麻醉效果良好。结论 腰硬联合麻醉应用于阴式子宫全切术，麻醉操作简单，易于开展，麻醉效果确切可靠。 【关键词】 腰硬联合； 阴式子宫全切术； 麻醉 【Abstract】 Objective To evaluate the effect of combined spinal epidural anesthesia in vaginal total hysterectomy. Methods 43 cases which were 29 to 53 years old, 48 to 74 kilogram weight and I or Ⅱ in ASA were randomly divided into two groups. There were 21 cases in control group(epidural anesthesia group) and 22 cases in therapy group(combined spinal epidural anesthesia group). Both groups were monitored for vital sign,ECG,SpO2 and drag response in the operation. Results All cases were steady in hemodynamics. There were no significantdifferences in HR, SpO2, ECG between two groups. In the comparison of anesthesia effect, therapy group was superior to control group. The excellent and good rate of the former was 100 percent, the latter? was 80.95 percent. In the control group, some cases had visceral drag responses. In the therapy group, there were no abdominal muscle tension, nausea and vomiting, pain reaction. The anesthesia effect was excellent. Conclusion The application of combined spinal epidural anesthesia in vaginal total hysterectomy is simple, feasable and realiable. 【Key words】 combined spinal epidural anesthesia；vaginal total hysterectomy；anesthesia 子宫全切手术时选用的麻醉方法已由单一硬膜外麻醉(EA)方式发展到现在的腰硬联合麻醉(CSEA)。我科自2005年2月～2008年4月对需要子宫全切的43例患者进行临床对照研究，现报道如下。 1 资料与方法 1.1 一般资料 共43例患者，均因子宫肌瘤行择期阴式子宫全切术，年龄29～53岁，平均43.7岁，体重48～74 kg，ASA Ⅰ～Ⅱ级，均无高血压、糖尿病等心肾、肝脏严重疾患。手术均由一组相同妇产科医生和麻醉师操作；所有患者无手术和腰麻、硬麻绝对禁忌症。两组患者平均年龄、病情程度等一般情况相似，统计学比较无显著差异（Pgt;0.05），具有可比性。 1.2 方法 采用统计学方法随机将病人分成硬膜外麻醉组(EA，对照组)21例，腰硬联合麻醉组(CSEA，治疗组)22例。所有患者常规术前用药，入室后常规监测ECG、BP、HR、SPO2等并建立静脉通道，术前常规肌注阿托品0.