连续腰麻与联合腰麻硬膜外麻醉用于子宫切除术病人的比较研究

Comparison of continuous spinal and combined spinal-epidural anesthesia in patients for uterectomy]

OBJECTIVE: To compare the anaesthetic effect and hemodynamic changes between the continuous spinal anaesthesia(CSA) and combined spinal-epidural anaesthesia (CSEA) in patients for uterectomy. METHODS: Sixty patients undergoing uterectomy were randomly divided into two groups: CSA group and CSEA group. Spinal anesthesia was performed at L2-3 interspace. An initial subarachnoid bolus of 0.5% hyperbaric bupivacaine 2 ml was injected in the CSA group; if analgesia did not reach T8, supplemental bupivacaine was injected by titrate incremental doses. In the CSEA group, epidural anesthesia was performed at T12-L1 with a catheter inserted into the epidural space for anesthesia maintenance, and then 0.5% hyperbaric bupivacaine 3 ml was injected to the subarachnoid at L2-3. The levels and times of sensory and motor block and hemodynamic changes were measured and analysed. RESULTS: The anesthetic dosage of the CSA group was smaller than that of the CSEA group (group P < 0.05). The times of sensory block to T8 or the maximal level and motor block were more rapid in the CSEA group than those of the CSA group (P < 0.05). Mean arterial pressure (MAP), which decreased significantly, was related with the baseline in the two groups; the time was 15 min and 25 min in the CSEA group and CSA group respectively (P < 0.05). There was no difference in the maximum decline of MAP in the two groups (P < 0.01). CONCLUSION: CSA is a safe technique of spinal anesthesia with small anesthetic dosages, more reliable and hemodynamically stable in patients for uterectomy.