不同椎管内麻醉方式在全子宫切除术中的临床应用(1)
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[摘要] 目的 比较四种不同的椎管内麻醉方式在全子宫切除术中的临床麻醉效果。 方法 选择择期行全子宫切除术患者100例，随机分为一点腰-硬联合麻醉组(CSEA1组)、两点腰-硬联合麻醉组(CSEA2组)、一点硬膜外麻醉组(EA1)和两点硬膜外麻醉组(EA2)，每组各25例。记录麻醉前、给药后5 min、15 min和30 min时的收缩压和心率的变化，观察各组的麻醉起效时间、术中麻醉效果和不良反应。 结果 四组患者术中均有不同程度的血压和心率下降，其中EA1和EA2组患者血压下降最为明显，CSEA1和CSEA2麻醉效果较EA1和EA2组好，其中CSEA2麻醉效果尤为显著。四组患者间恶心、呕吐、呼吸困难、头痛并发症的发生率比较，差异无统计学意义(P > 0.05)。 结论 CSEA2麻醉起效快，麻醉效果好，是全子宫切除术较好的椎管内麻醉方式。
[关键词] 腰-硬联合麻醉；硬膜外麻醉；全子宫切除术
[中图分类号] R719.8 [文献标识码] B [文章编号] 1673-9701(2012)04-0119-03
Clinical application of different spinal Anesthesia on total hysterectomy
CHEN Jiangshui
Department of Anesthesiology, Fenghua City People's Hospital, Fenghua 315500, China
[Abstract] Objective To compare four different methods of spinal anesthesia in total hysterectomy in clinical anesthesia.Methods All of 100 patients undergoing hysterectomy were randomly and equally divided into four groups：one point back-epidural anesthesia group (CSEA1 group), two point back-and epidural anesthesia group (CSEA2 group), one point epidural anesthesia group (EA1)and two point epidural anesthesia group (EA2). Anesthesia before and 5 minutes, 15 minutes and 30 minutes after anesthesia, systolic blood pressure and heart rate changes were observed in each group. The onset time of anesthesia, anesthesia effects and adverse reactions were also recorded. Results Four group patients showed varying degrees of intra-operative low blood pressure and heart rate, especially for patients in EA1 and EA2 group. Anesthetic effect in CSEA1 and CSEA2 was much better than EA1 and EA2, and anesthetic effect in CSEA2 was particularly significant.There was no significant difference in the incidence of nausea, vomiting, difficulty breathing, headache was not statistically significant between four group patients (P > 0.05). Conclusion CSEA2 could lead to rapid onset of anesthesia and anesthetic effect, and is the best spinal anesthesia method in total hysterectomy.
[Key words] Waist-and epidural anesthesia；Epidural anesthesia； Hysterectomy
全子宫切除术手术部位迷走神经极为丰富、涉及神经平面较广，一般麻醉方法很难使镇痛和肌肉松弛达到满意程度，临床上子宫全切除术常采用的麻醉方法为椎管内麻醉 ......
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