两点法腰硬联合麻醉在子宫全切除术中的应用

目的观察两点法腰硬联合麻醉用于子宫全切术的临床效果。方法选择ASAⅠ～Ⅱ级行子宫全切术患者120例,随机分成两组,每组60例,Ⅰ组为一点法,即L2～3腰椎单次腰麻后置入硬膜外导管;Ⅱ组为两点法,即T12～L1行硬膜外置管,再行L2～3单次腰麻。比较两组患者血流动力学变化、麻醉效果,记录腰麻平面不对称例数、硬膜外腔用药量、需要辅助用药的例数及术后头痛、腰背痛情况。结果在进腹探查和牵拉宫颈时,Ⅰ组患者心率下降幅度大于Ⅱ组患者的心率下降幅度（P〈0.05）;Ⅱ组肌松满意度和防止牵拉反应明显优于Ⅰ组（P〈0.05）;腰麻平面不对称例数、硬膜外腔用药量和需要辅助用药的例数Ⅰ组多于Ⅱ组。结论两点法腰硬联合麻醉用于子宫全切术麻醉效果确切,更合理安全。

The application of two-point method of lumbar epidural anesthesia in total hysterectomy

Objective To observe the clinical effects of two-point method of lumbar epidural anesthesia in total hysterectomy.Methods Select 120 ASA Ⅰ～Ⅱ grade hysterectomy patients who have been randomly divided into 2 groups,each group include 60 cases.Group Ⅰ use the point method that a single L2～3 lumbar epidural catheter was inserted after spinal anesthesia.Group Ⅱ use two-point method that T12～L1 epidural catheter was inserted,and then re-L2-3 spinal single.Compare the two groups’change of hemodynamic and anesthetic effect,record the number of cases of spinal anesthesia planar unsymmetrical,the amount of epidural medication,the number of patients require secondary treatment and postoperative headache,cases of back pain.Results When they were being in the exploration and pulling the cervix into the abdomen,the heart rate of group Ⅰ declined more than that in group Ⅱ（P 〈0.05）.Group Ⅱ was significantly better than groupⅠin the satisfaction of muscle relaxation and prevent the reaction of traction（P〈0.05）.But the number of cases of spinal asymmetry plane,the amount of epidural medication and the number of cases required adjuvant in group Ⅰ is more than that in group Ⅱ.Conclusion The effect of CSEA on hysterectomy is more reasonable and safe.