两种硬膜外麻醉方法在阴式全子宫切除术中的临床观察  

Clinical observation on two kinds of epidural anesthesia methods for vaginal total hysterectomy

作　　者：程殿臣[1] 张文伟[1] 程殿威[2] 

机构地区：[1]兰州市妇幼保健院麻醉科,730030 [2]兰州大学第一医院心脏外科

出　　处：《中国医师进修杂志》2010年第12期24-26,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的比较硬膜外麻醉两点法和一点法在阴式全子宫切除术中的临床麻醉效果。方法选择择期行阴式全子宫切除术的患者80例，按随机数字表法分成Ⅰ、Ⅱ两组，每组各40例。Ⅰ组采用L1-2向头端置管和L3-4向尾端置管硬膜外麻醉两点法。Ⅱ组采用L2-5向头端置管硬膜外麻醉一点法。术中观察麻醉平面、麻醉起效时间和临床麻醉效果等。结果麻醉平面上界Ⅰ组较Ⅱ组高（P〈0．05），麻醉起效时间Ⅰ组较Ⅱ组短（P〈0．05）。Ⅰ组麻醉效果优率（92．5％，37/40）明显高于Ⅱ组（70．0％，28／40）（p〈0．05）。Ⅰ组与Ⅱ组比较，维持时间长、追加量和用药总量少（P〈0．05）。结论硬膜外麻醉两点法局麻药物的追加量和手术期间总的局麻药物用量少，麻醉起效快，药效维持时间长，临床麻醉效果确切，麻醉镇痛完善、术中肌肉、宫颈松弛度好，牵拉反应少而轻，应激反应轻微，患者术中更加平稳，是阴式全子宫切除术临床麻醉的较好选择。Objective To compare the effect of epidural anesthesia on vaginal total hysterectomy. Methods Eighty patients with vaginal total hysterectomy were selected and randomly divided into group Ⅰ （40 cases） and group Ⅱ （40 cases）. The patients of group Ⅰ were punctured with two-point method to the first tube of epidural in L1-2 and to the tail tube in L3-4. The patients of group Ⅱ were punctured with one-point method to the first tube of epidural in L2-3. Observed the level of anesthesia,induction period and anesthetic effect of all patients. Results The upper bound level of anesthesia was higher in group Ⅰ than that in group Ⅱ （P 〈 0.05）, the induction period was shorter in group Ⅰ than that in group Ⅱ （P 〈 0105 ）. The anesthetic effect was better in group Ⅰ （92.5%, 37/40） than that in group Ⅱ （70.0%, 28/40）（P 〈 0.05）. There were significant difference in maintain time,dose of boost and total between group Ⅰ and group Ⅱ （P 〈0.05）. Conclusion Two-point method of epidural anesthesia is better for vaginal total hysterectomy,as it can provide rapidly and completely anesthetic effects.

关 键 词：麻醉 硬膜外 两点法 一点法 阴式全子宫切除 

分 类 号：R614[医药卫生—麻醉学]