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

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的应用的可行性。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组选择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（Targetcontrolled infusion,TCI）的静脉给药方法,记录观察术中输液、输血量、麻醉用药量,术中MAP、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进行,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。

Application of epidural anesthesia combined with intravenous anesthesia in laparoscopic assisted vaginal hysterectomy

Objective To investigate the epidural block combined with intravenous anesthesia in laparoseopic 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 groups,A group of 54 cases of patients who chose to enter after the first intervertebral space L2～3 epidural external cavity puncture,catheter upward 4cm.The amount given after the experiment didn＇t 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 drugs,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 significantly 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 were safe through the operative period,patients returned directly after completion of the recovery ward,there was no significant postoperative complications after anesthesia.Conclusion The epidural block combined with intravenous anesthesia in laparoscopic assisted vaginal hysterectomy is safe and effective.