两种麻醉方法行PPH手术的临床观察

目的探讨静脉全麻＋局麻与腰麻两种麻醉方法行吻合器痔上黏膜环切钉合术（PPH）手术的安全性和手术时间。方法选择行PPH手术患者64例，男30例，女34例，年龄20～75岁，体重49—94kg，ASA分级Ⅰ～Ⅱ级。随机分两组：静脉全麻＋局麻组33例，选用芬太尼0．05～0．1mg静脉给药，3min后静脉推注丙泊酚2mg·kg-1，用1％利多卡因做肛周局部浸润麻醉，静脉麻醉维持根据手术时间和患者对手术反应追加丙泊酚0．5～1mg·kg-1；腰麻组选用0．25％罗哌卡因4mL，注入蛛网膜下腔。结果入选患者性别、年龄、体重和术式比较，差异均无统计学意义（P〉0．05），具有可比性；两组比较收缩压（SBp）、舒张压（DBp）、心率（HR）、呼吸（RR）、血氧饱和度（SpO：）差异均无统计学意义（P〉0．05）；手术时间两组比较差异有统计学意义（P〈0．05）。结论两组麻醉方法血流动力学平稳，无呼吸抑制；静脉全麻＋局麻组手术时间比腰麻组短，利于手术量多的接台手术。

Clinical Observation of PPH Operation under Two Anesthetic Methods

Objective To explore the safety and operative time of the procedure for prolapse and hemorrhoids （PPH）under intravenous general anesthesia ＋ local anesthesia and spinal anesthesia. Methods Of 64 cases of PPH,30 cases were male,34 cases female, aged 20 - 75 years, body weighted 49 - 94 kg, ASA grade Ⅰ～Ⅱ. They were randomized into two groups. In an intravenous general anesthesia ＋ local anesthesia group （33 cases） ,fentanyl 0.05- 0.1 tug was used for intravenous medication. Propofol was injected intrave- nously 3 min later,2 mg· kg - 1 ; 1% lidocaine was used for local infiltration anesthesia around the anus ; for intravenous anesthesia maintenance, propofol 0.5 - 1 mg ~ kg - 1 was supplemented according to the operative time and the reaction of patient. In a spinal anesthesia group ,0.25% ropivacaine 4 mL was injected in sub- arachnoid cavity. Results The differences in sex, age, body weight and operative method in comparison a- mong the patients did not present statistical significance（ P 〉 0.05 ）, indicating the comparability. The differ- ences in systolic blood pressure （ SBP）, diastolic blood pressure （ DBP）, heart rate （ HR）, respiratory rate （RR） and oxyhemoglobin saturation（ SPO2 ）did not present statistical significance between two groups（ P 〉 0.05 ）. The difference in the operative time was significant statistically between two groups （ P 〈 0.05 ）. Con- clusion The anesthetic methods in two groups achieve the stable hemodynamics, without respiratory inhibi- tion. The operative time in the intravenous general anesthesia ＋ local anesthesia group is shorter than that in the spinal anesthesia group,which contributes to the high capacity of consecutive operation.