腰-硬联合阻滞复合浅全麻在妇科腹腔镜手术的临床应用研究

目的:探讨腰-硬联合阻滞(combined spinal epidural anesthesia,CSEA)技术辅以静脉浅全麻在妇科腹腔镜手术中的临床麻醉效果及安全性。方法:在腰-硬联合阻滞后分别予以力月西、杜氟合剂、异丙酚辅助麻醉施行腹腔镜妇科手术;回顾分析269例妇科腹腔镜手术的临床麻醉数据,进行统计分析,分析其麻醉效果、副作用。结果:术中麻醉效果良好,镇静充分,DBP、SBP、HR指标在CSEA后10min内有变化但平稳(P>0.05),均在正常范围;CO2气腹后10min与气腹前比较,HR增快,有统计学意义(P<0.05),RR加快、PETCO2升高,有统计学意义(P<0.01),两者变化最为显著,但仍可维持在正常范围,而SpO2变化幅度不显著(P>0.05),在气腹30min后,各项指标均有所改善,排气后10min各项指标与气腹前比较无统计学意义(P>0.05),269例患者均顺利完成妇科腹腔镜手术,无一例发生麻醉并发症及意外。结论:在妇科腹腔镜手术中,应用腰-硬联合阻滞辅以静脉浅全麻,在强化麻醉管理、充分吸氧的前提下能很好的控制血流动力学和呼吸功能的变化而维持正常的生命体征,麻醉效果良好,可在选择适应证的前提下推广应用。

The study of clinical application of combined spinal epidural anesthesia compounded shallow general anesthesia in gynecological laparoscopy

Objective:To explore the effect and safety of combined spinal epidural anesthesia(CSEA) compounded shallow general anesthesia in gynecological laparoscopy.Methods:The gynecological laparoscopic operations were performed under combined spinal epidural anesthesia followed by the assistant anesthesia of midazolam,the mixture of pethidine and droperidol,and propofol;the data of 269 gynecological laparoscopic operations were retrospectively analyzed statistically,and anaesthestic effect and side effect were observed.Results:The anesthesia effect was good with adequate sedation in the operation.The indexes such as DBP,SBP,HR changed stably within 10 minutes after CSEA(P>0.05).Compared with those before pneumoperitoneum HR increased significantly(P<0.05),RR accelerated and PETCO2 rose significantly(P<0.01) but keep normal,and SpO2 had no significant change(P>0.05) within 10 min after CO2 pneumoperitoneum.All the indexes were improved 30 min after pumping CO2 pneumoperitoneum.The indexes after discharging CO2 pneumoperitoneum were very close to those before establishment of CO2 pneumoperitoneum(P>0.05).269 patients underwent gynecological laparoscopic operations successfully without complications and accidents related to anesthesia.Conclusions:As adequate anesthesia condition and inspired oxygen were given,combined spinal epidural anesthesia compounded shallow general anesthesia can well control the changes of hemodynamics and respiratory function in gynecological laparoscopy,thus normal vital signs and good anesthesia effect maintained.The technique can be further applied to practice after choosing indication.