硬膜外麻醉下咪唑安定复合氯胺酮在妇科腹腔镜手术中的应用(附120例报告)

目的 研究硬膜外麻醉下咪唑安定复合氯胺酮在妇科腹腔镜手术中应用的安全性和可行性.方法 选择妇科腹腔镜手术患者120例.ASAⅠ-Ⅱ级.常规行硬膜外穿刺,成功后注药,测平面满足手术所需,切皮前缓慢静推咪唑安定0.1 mg/kg,氯胺酮1.0 mg/kg混合液5 min后开始气腹,术中以咪唑安定＋氯胺酮微泵输注,速度分别为0.1 mg/（kg·h）^-1和1.0 mg/（kg·h）^-1.结果 术中采用改良OAA/S法评定镇静程度,大部分患者控制在2～3分;术中MAP、HR较麻醉前升高（P＜O.05）,但均在正常范围内,气腹后即刻、气腹后30 min的RR、SpO2与麻醉前比较无统计学意义（P＞0.05）.结论 硬膜外麻醉下咪唑安定复合氯胺酮在妇科腹腔镜手术的应用,具有一定的安全性和可行性.

Application of Midazolam Compound With Ketamine under Epidural Anesthesia (EA) In Gynecological Laparoscopic Surgery

Objective To research the safety and feasibility about the application of Midazolam compound with ketamine under epidural anesthesia（EA） in gynecological laparoscopic surgery. Methods We choosed 120 patients in use of aparoscopic operation, ASA Ⅰ - Ⅱ epidural paracentesising in routine methods and injecting medicine after successfully paracentesising. When the plane is satisfied of operation, we began to cut the skin. 5 minutes before cutting the skin and beginning pneumoperitoneum, we had already injected the mixed liquor of Midazolam （0.1 mg/kg ）and ketamine （1 mg/kg ） slowly in vien. Minipump infusion of Midazolam compound with ketamine was used in opration and the speed is 0.1 mg·kg^-1·h^-1 andlmg/（kg·h）. Results We used improved OAA/S method to evaluate the degree of analgesia in operation..And most patients is 2 - 3 min. In operation, the MAP,HR was rised after anesthesia（ P 〈 0.05 ） ,but it was within normal limits. The numerus of RR and SpO2 immediately after begirming pneumoperitoneum compared with 30 min after pneumoperitoneum and before anesthetized had not statistically significant（ P 〉 0.05）. Conclusion Theapplication of midazolam compound with ketamine under epidural anesthesia（EA） in gynecological laparoscopic surgery might have determinate safety and feasibility .