4种麻醉方法在肛肠手术患者中的应用比较  

Comparison of four methods of anesthesia in Patients with anorectal surgery

作　　者：李媛[1] 王世禄[1] 衣晓卓[1] 张娇[1] 

机构地区：[1]海南医学院附属医院麻醉科,海口570102

出　　处：《中国综合临床》2016年第2期105-108,共4页Clinical Medicine of China

基　　金：海南省自然科学基金资助项目（813189）

摘　　要：目的观察与比较4种麻醉方法在肛肠手术患者中的应用效果。方法肛肠疾病手术患者100例根据随机抽签原则分为Ⅰ组（低剂量腰硬联合麻醉）、Ⅱ组（低位硬膜外麻醉）、Ⅲ组（骶麻）与Ⅳ组（局部麻醉），每组25例，观察4组的麻醉起效时间、患者满意度、术后不良反应以及血流动力学情况。结果Ⅰ组和Ⅳ组麻醉起效时间分别为（4．12±2．11）min与（3．69±1．11）min，明显短于Ⅱ组和Ⅲ组（10．34±3．10）min与（12．55±3．23）min（P均〈0．05）。4组的麻醉满意度分别为96.0％（24／25）、84．0％（21／25）、64．0％（16／25）与40．0％（10／25），4组间比较差异有统计学意义（P〈O．05），且Ⅰ组满意度最好。4组术后尿潴留发生率差异无统计学意义（P〉0．05），但Ⅳ组术后恶心呕吐（3例）、牵拉痛（12例）、头痛（4例）发生率明显高于其他3组（P均〈0．05）。4组术前、术中的平均动脉压，血氧饱和度与脉搏在组内与组间比较差异均无统计学意义（P均〉0．05）。结论相对于其他麻醉方法，低剂量腰硬联合麻醉在肛肠手术中的应用具有更快的麻醉起效时间与麻醉满意度效果，不良反应少，能保持机体的血流动力学平稳，值得推广应用。Objective To observe and compare the effects of four methods of anesthesia in patients with anorectal surgery. Methods One hundred patients with anorectal surgery were equally divided into the group Ⅰ （low-dose epidural anesthesia） , group Ⅱ （ epidural anesthesia） , group Ⅲ （caudal） and group Ⅳ （ local anesthesia） based on a random draw principles, each group of 25 cases. The onset time of anesthesia, patient satisfaction,postoperative adverse reaction and hemodynamics were observed in the 4 groups. Results The anesthesia onset time in the group Ⅰ and group Ⅳ were （4.12±2.11） min and （3.69±1.11） min, significantly shorter than group Ⅱ and group Ⅲ （ （10. 34±3. 10） min and （ 12. 55±3.23） min, P〈0. 05） . Anesthesia satisfaction of four groups were 96. 0% （24/25） , 84. 0% （21/25） , 64. 0%（16/25） and 40.0% （ 10/25 ） , the differences among 4 groups were statistically significant（ P〈0. 05 ）, and the anesthesia satisfaction of guoup I was the best. Four groups of postoperative urinary retention difference were not statistically significant （P〉0. 05 ） , but the postoperative nausea and vomiting（n = 3 ） , referred pain（ n = 12） , headaches （n = 4） and other adverse events in the group IV were significantly higher than the other 3 groups （P〈0. 05） . Differences between-groups and inner-group were not statistically significant of the intraoperative mean arterial pressure, oxygen saturation and pulse rates of the four groups （P〉 0. 05） . Conclusion Compare to other anesthetic methods, low-dose epidural anesthesia in anorectal surgery applications with faster onset time of anesthesia and anesthesia satisfaction results, it has litter adverse reactions and maintain stable hemodynamics body, worthy applications.

关 键 词：麻醉 肛肠手术 不良反应 血流动力学 腰硬联合麻醉 

分 类 号：R197.32[医药卫生—卫生事业管理]