硬膜外阻滞复合静脉全麻在腹腔镜辅助阴式子宫全切术中的应用  

Application ofepidural anesthesia combined with intravenous anesthesia in laparoscopic assisted vaginal hysterectomy

作　　者：张立冬 

机构地区：[1]辽宁省辽阳市辽化总医院麻醉科,111003

出　　处：《辽宁医学杂志》2012年第5期233-235,共3页Medical Journal of Liaoning

摘　　要：目的探讨硬膜外阻滞复合静脉全麻在腹腔镜辅助阴式子宫全切术中应用的可行性。方法选择34～68岁腹腔镜辅助阴式子宫全切术108例,ASAⅠ～Ⅱ级,随机分为A、B两组。A组54例患者入室后先行L2～3椎间隙硬膜外腔穿刺,向上置管4cm。给予试验量后观察无不适再施行静脉全麻;B组采用全凭静脉麻醉。两组病例术中均采用了靶控输注(TCI)的静脉给药方法,观察并记录术中输液量、输血量、麻醉用药量,术中平均动脉压(MAP)、心率(HR)变化及术终苏醒期一般情况。结果 A组整个麻醉手术中血流动力学稳定,肌肉松弛,所用静脉全麻药、肌松药等明显比B组少(P<0.01),苏醒快、无痛,硬膜外阻滞复合静脉全麻利于腹腔镜辅助阴式子宫全切术的开展。两组患者麻醉过程顺利,所有患者均安全度过手术期,术毕复苏后直接送回病房,术后均无明显的麻醉后并发症。结论硬膜外阻滞复合静脉全麻在腹腔镜辅助阴式子宫全切术中是安全有效的。Objective To investigate the epidural block combined with intravenous anesthesia in laparoscopic assisted vaginal hysterectomy in the feasibility of the application.Methods 34~68-year-old laparoscopically assisted vaginal hysterectomy 108 cases,ASA Ⅰ~Ⅱ grade,were randomly divided into A,B group,A group of 54 cases of patients who choose to enter after the first intervertebral space L2~3 epidural extemal cavity puncture,catheter upward 4cm.The amount given after the experiment does not further the purposes of nonobservation of intravenous anesthesia.B TIVA group.Two groups of patients in both cases a target-controlled infusion（Target controlled infusion,TCI） method of intravenous administration,recording observation during infusion,blood volume,the volume of narcotic drμgs,intraoperative MAP,HR changes and the operation period of the end to wake up under normal circumstances.Results A group of the entire anesthesia hemodynamic stability,muscle relaxant,used intravenous anesthetic-wide,such as muscle relaxants signiricantly less than the B group（P0.01）,to wake up fast,painless,epidural block combined with intravenous-wide ma conducive to laparoscopically assisted vaginal hysterectomy process.Two groups of patients the course of the smooth conduct of anesthesia,all patients are safe through the operative period,patients returned directly after completion of the recovery ward,there was no significant postoperative complications after anesthesia.Conclusions The epidural block combined with intravenous anesthesia in laparoscopic assisted vaginal hysterectomy is safe and effective.

关 键 词：硬膜外阻滞复合静脉全麻 腹腔镜 阴式子宫全切 

分 类 号：R614[医药卫生—麻醉学]