硬膜外持续泵注与分次注药在子宫全切术中的效果观察

目的观察硬膜外持续泵注局麻药用于子宫全切术的临床效果。方法将40例拟行子宫全切术的患者随机分为持续泵入给药组（A组）和间断给药组（B组）。每组20例,硬膜外用药均为0.2%丁卡因＋1.6%利多卡因。两组均在L2～3硬膜外穿刺成功并给予实验量后,A组（20例）硬膜外先予以1ml/min速度注入,10～15min后以0.15～0.17ml·kg-1·h-1速度持续输注药物至手术结束 B组（20例）初量注入10～15ml,间隔5～10min分次注完,每小时追加5～8ml。分别测定麻醉前及硬膜外给药后的血压（BP）、心率（HR）、SpO2、镇痛起效时间和用药总量 首次注药后至手术结束时针刺皮肤测阻滞平面,同时记录改良Bromage评分,术中肌松质量由手术者评定（手术者为同一组人）,分为很满意、满意和不满意。结果A组血压波动显著降低,与B组比较差异有统计学意义（P〈0.05）,两组间皮肤阻滞平面、用药总量、Bromage评分和术中肌松情况及SpO2比较差异无统计学意义（P〉0.05）。镇痛起效时间B组比A组短。结论硬膜外微泵持续泵入给药方法用于子宫全切术可以达到间断给药法同样的麻醉效果,血压、心率平稳,用药量少,是一种较为安全的给药方法。

Observation of the effect of epidural anesthesia by computerized infusion pumpand conventional injection in total hysterectomy

Objective To observe the effect of epidural anesthesia by computerized infusion pump and conventional injection. Methods Forty patients scheduled for obstetric operation were divided into a continuous pump infusion group （Group A,n=20） and a conventional injection group （Group B,n=20）.The initial doses of 0.2% dicaine ＋1.6% lidocaine were respectively injected into the patients.At first,The dose of 1 ml of mixed fluid per min was continuously pumped in 10-15min, then the dose of 0.15-0.17ml ·kg-1·h-1 was continuously pumped to maintain the anesthesia till the end of the operation in Group A. The dose of 10-15 ml of mixed fluid was injected and 6-8 ml of fixed fluid was injected 60 rain later in Group B. Results Blood pressure in some patients markedly decreased at 70 min after the first injection in Group B while it is rela- tively stable in Group A （P〈O.OS）.The number of patients who had to inject ephedrine to raise the blood pressure in Group A was smaller than that in Group B during the operation （P〈0.05）.There was no significant difference in the anesthetic level be- tween Group A and Group B（P〉O.05）. Conclusion Epidural anesthesia by computerized infusion pump is safe,which can not only provide an excellent anesthetic effect but also keep the hemodynamics stable.