不同麻醉方法在非住院肛肠手术的应用  

Different anesthesia methods applied in ambulatory anorectal surgery

作　　者：袁建虎[1] 李天佐[2] 杨茜芳[1] 叶明[3] 张旭光[1] 

机构地区：[1]北京市二龙路医院麻醉科,100011 [2]首都医科大学附属北京世纪坛医院 [3]北京市二龙路医院肛肠外科

出　　处：《北京医学》2015年第8期763-765,768,共4页Beijing Medical Journal

基　　金：首都医学发展科研基金(2009-3023);北京市西城区科技计划项目(201002)

摘　　要：目的 探讨改良骶管阻滞、骶管阻滞复合镇静、静脉全身麻醉和吸入全身麻醉用于非住院肛肠手术患者的效果和安全性。方法 择期ASAⅠ～Ⅲ级行非住院手术治疗的肛肠手术患者120例,随机分为4组,每组30例：骶管阻滞组（Ⅰ组）、骶管阻滞＋镇静组（Ⅱ组）、静脉全麻组（Ⅲ组）、吸入全麻组（Ⅳ组）。结果 Ⅰ组、Ⅱ组各观察时点MAP与基础值比较差异均无统计学意义（P〉0.05）,两组T5时的HR较T1时降低（P〈0.05）。Ⅲ组和Ⅳ组T2和T5时MAP、HR均显著低于T1时（P〈0.05）。改良骶管阻滞成功率为95%（57/60）。4组PACU停留时间分别为（40.2±8.5）min、（45.7±9.8）min、（42.3±9.9）min、（43.5±10.2）min,组间比较差异无统计学意义;离院前疼痛VAS评分各组均〈3分。结论 改良骶管阻滞复合咪达唑仑镇静麻醉效果满意、不良反应少,可作为非住院肛肠手术的首选麻醉方法;喉罩静脉或吸入全身麻醉可作为有益补充。Objective To investigate the efficacy and safety of modified caudal block,caudal block plus sedation,intravenous anesthesia and inhalation anesthesia applied respectively to ambulatory anorectal surgery.Methods One hundred and twenty cases of outpatients of ASAⅠ～Ⅲ undergoing elective ambulatory anorectal surgery were randomly divided into 4 Groups（30 each）：GroupⅠ（the caudal block group）,Group Ⅱ（the caudal block plus sedation group）,Group Ⅲ（intravenous anesthesia group）,Group Ⅳ（inhalation aanesthesia group）.Results Modified caudal block success rate was95%（57/60）,and it had little effect on blood pressure and heart rate.In addition,caudal block combined with midazolam could effectively reduce patient stress and anxiety,improve intraoperative comfort.There was significant difference in trough blood pressure,decrease of heart rate after inducement of the two groups with general anesthesia（P 〈0.05）.The PACU time of the four groups was（40.2±8.5）min,（45.7±9.8） min,（42.3±9.9） min,（43.5±10.2） min respectively and there was no statistical difference between the four groups.The VAS of each group＇s was less than 3 before leaving hospital.Conclusion Caudal block anesthesia combined with midazolam can be the first choice of ambulatory anorectal anesthesia because of its satisfying effect and less side effects.LMA intravenous anesthesia or inhalation anesthesia can be used as alternatives.

关 键 词：非住院手术 肛肠手术 骶管阻滞 镇静 全麻 喉罩 

分 类 号：R614[医药卫生—麻醉学]