丙泊酚镇静剂量用于腰-硬联合麻醉下妇科腹腔镜手术的可行性

目的：探讨镇静剂量的丙泊酚用于腰-硬联合麻醉下妇科腹腔镜手术的可行性及安全性。方法：选择腰-硬联合麻醉下行妇科腹腔镜手术的患者60例，ASAⅠ～Ⅱ，腰麻阻滞完善后，丙泊酚负荷剂量1mgZkg，连接微量泵泵注丙泊酚25～75μg·kg^-1·min^-1维持术中镇静。以患者OAA／S评分为镇静指标，并观察对循环和呼吸的变化，分析其麻醉效果、不良反应。结果：术中麻醉效果良好，OAA／S评分3分即为预期的深度，术中各时点收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、脉搏血氧饱和度（SP02）差异无统计学意义（P〈0．05），气腹后5min心率（HR）增快，差异有统计学意义（P〈0．05），呼吸（RR）加快，差异有统计学意义（P〈0．01），SPO2变化幅度不显著（P〉0．05），60例患者均顺利完成手术，无麻醉并发症发生。结论：镇静剂量的丙泊酚用于腰-硬联合麻醉下妇科腹腔镜手术患者的可控性强，在加强麻醉管理和监测的前提下，能很好的控制呼吸和循环功能的变化，同时镇静深度适宜，可有效抑制患者术中的应激反应。

Laparoscopic surgery under combined spinal-epidural anesthesia with propofol at sedative amount

Objective:To discuss the feasibility and security of laparoscopic surgery under combined spinal-epidural anesthesia with propofol at sedative amount.Method:Selected 60 patients treated with laparoscopic surgery under combined spinal-epidural anesthesia(ASA Ⅰ～Ⅱ).After complete waist anaesthesia block,propofol at loaded dosage of 1mg/kg and microdose propofol at 25 μg～75 μg·kg-1·min-1 were applied to maintain sedation during surgery.Taking the patient of OAA/S's grades as sedative index,observed the variation of circulation and respiration,and analyzed its sedative effect and side effect.Result:Sedative effect was well in surgery.OAA/s grade was 3 consistent with expected depth.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),or pulse oxygen saturation(SPO2)showed no significant differences(P>0.05),while 5 minute later after pneumoperitoneum,heart rate(HR)and respiration rate(RT)increased significantly(P<0.05).The variation of PO2 was not significant(P>0.05).60 patients had successful surgery without any complication.Conclusion:Propofol with sedative amount can strengthen the control for laparoscopic surgery under combined spinal-epidural anesthesia,regulate the change of circulation and respiration,keep the appropriate degree of sedation and inhibit the stress response during surgery.