硬膜外麻醉与腰麻用于疝修补术的比较研究

目的：观察硬膜外麻醉与腰麻在疝修补术中的麻醉管理及相关并发症，确定硬膜外麻醉在疝修补术麻醉中的优越性。方法选取2012年10月至2016年9月四川护理职业学院附属医院择期腹股沟疝修补术(包括传统疝修补和无张力疝修补)的手术患者共100例，美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级，随机分为硬膜外麻醉组(n=50)和腰麻组(n=50)，记录患者麻醉前、麻醉后和麻醉结束时平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)的变化；术中患者对手术配合情况；术后尿潴留以及头痛发生率等。结果麻醉后硬膜外麻醉组 MAP、HR无明显变化，腰麻组 MAP、HR 波动明显(P <0.05)；硬膜外麻醉组能通过咳嗽或憋气配合医生确认疝囊，腰麻组未能成功(P <0.05)；术后尿潴留硬膜外麻醉组明显少于腰麻组(P <0.05)；术后头痛发生率硬膜外麻醉组明显低于腰麻组(P <0.05)。结论与腰麻相比，硬膜外麻醉用于疝修补术，患者血压心率变化小，循环稳定，能更好地配合手术，且相关并发症发生率低，术后无需去枕平卧，患者舒适度增加。

A Comparative Study of Epidural Anesthesia with Spinal Anesthesia in Hernia Repair

Objective To explore the superiority of epidural anesthesia in the anesthesia of hernia repair by analyzing the anesthesia management and related complications of epidural anesthesia (EA)and spinal anesthesia (SA).Methods 100 patients,who were rated as class Ⅱ and Ⅱ risk by American Society of Anesthesiologists (ASA)criteria and underwent elective inguinal hernia repair including traditional hernia repair and tension-free hernia repair from October of 2012 to September of 201 6 in The Affiliated Hospital of Sichuan Nursing Vocational College,were randomly divided into the EA group (n = 50 )and the SA group (n = 50 ).The changes of mean arterial pressure (MAP),heart rate (HR),blood oxygen saturation (SpO2 )were recorded before and after anesthesia and at the end of operation respectively.The other data including the condition of patients during operation,the postoperative urinary retention and the incidence of headache after operation were also recorded and analyzed.Results The MAP and HR of the EA group didn′t change obviously,while those of the SA group fluctuated significantly,and the difference between the two groups was significant (P <0.05).The patients in the EA group could cooperate with the doctor to identify hernial sac by coughing or choking,while the patients in the SP group couldn′t,and the difference was significant (P <0.05).The postoperative urinary retention of the EA group was less than that of the SA group and the incidence of headache after operation in the EA group was also lower than that in the SA group,and the differences were significant between the two groups (P < 0.05 ).Conclusion Compared with spinal anesthesia,epidural anesthesia in the hernia repair has many advantages including fewer changes in blood pressure and heart rate,more stability in circulation,better cooperation between patients and doctors,lower rate in complication incidence,no need to lie after operation,and more comfort for patients.