硬膜外麻醉复合静脉全麻用于腹腔镜经阴式全子宫切除术的临床研究

目的探讨硬膜外麻醉复合静脉全麻用于腹腔镜经阴式全子宫切除术中的临床应用。方法选择42～65岁,ASAⅠ～Ⅱ级,择期行腹腔镜辅助阴式子宫全切术60例,随机分为Ⅰ、Ⅱ两组,Ⅰ组(硬膜外麻醉复合静脉全麻)病人入室行L2～3或L3～4椎间隙硬膜外腔穿刺,向上置管3～4cm,给予试验量后观察无不适再施行静脉全麻;Ⅱ组(静脉全麻)采用全凭静脉麻醉。两组病例均采用TCI静脉给药方法,记录全麻用药量,术中MAP、HR变化、子宫附着韧带松弛度评级、手术时间及术毕苏醒时间;结果Ⅰ组子宫附着韧带松弛度优于Ⅱ组,手术时间及术毕苏醒时间短于Ⅱ组,Ⅰ组血流动力学稳定,所用静脉全麻药、肌松药等明显比Ⅱ组少(P<0.01)。结论硬膜外麻醉复合静脉全麻在腹腔镜经阴式全子宫切术中可达到满意的子宫松弛,缩短手术时间,苏醒快,无痛,麻药用量减少,安全舒适。大大减轻患者的医疗费用及痛苦,尤为适合基层医院开展。

Clinical Research on Application of Epidural Anesthesia Combined with Intravenous Anesthesia in Laparoscope AssistedVaginal Hysterectomy

Objective To explore the clinical application of epidural anesthesia combined with intravenous anesthesia in laparoscopically assisted vaginal hysterotomy （LAVH）. Methods 60 patients undergoing LAVH were randomly divided into two groups. Group I received general intravenous anesthesia combined with epidural anesthesia, and group Ⅱ received general intravenous anesthesia alone. The TCI intravenous injection method was used in two groups. The intraoperative changes of MAP and HR, uterus attached ligament relaxation degree, operation time and waking time were recorded. Results The uterus attached ligament relaxation degree of group Ⅰ was better than that of group Ⅱ, while the operation time and waking time were shorter than those of group Ⅱ, the dosages of intravenous anesthetics and muscle relaxant were fewer than those of group Ⅱ （P 〈0.01）. Conclusions The general intravenous anesthesia combined with epidural anesthesia in the LAVH has satisfactory hysteranesis, which can reduce the operation time, waking time and anesthetic dosage.