摘要
目的 探讨硬膜外麻醉复合异丙酚靶控输注在妇科腹腔镜手术中的可行性.方法 择期妇科腹腔镜手术患者40例,ASAⅠ～Ⅱ级,随机分为硬膜外麻醉复合异丙酚靶控输注组(E组)和气管插管全身麻醉组(G组),每组20例.E组:采用L1～2连续硬膜外麻醉,局麻药为1.73%碳酸利多卡因,麻醉平面控制在T6以下.气腹前3 min静脉注射芬太尼0.1 mg,静脉靶控输注血浆靶浓度为1～2 mg/L的异丙酚,手术结束时停止输注异丙酚.G组:以咪唑安定0.03 mg/kg、异丙酚1.5～2 mg/kg、芬太尼2 μg/kg、维库溴铵0.1 mg/kg静脉注射诱导插管,术中控制呼吸:潮气量(TV)8 ml/kg,呼吸频率(RR)12次/min,吸呼比(I∶ E)1∶ 2,吸入1%～2%异氟醚和间断静脉注射维库溴铵、芬太尼维持麻醉,手术结束时停止吸入异氟醚.分别在入室时(T1)、气腹时 (T2)、气腹后10 min (T3)、气腹后20 min(T4)、术毕(T5)抽动脉血行pH、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)分析,并记录相应时刻的平均动脉压(MAP)、心率(HR)和脉搏氧饱和度(SpO2).结果 ① PaO2的变化: E组T2较T1升高(P＜0.01),T3、T4、T5较T1升高(P＜0.05);G组T2 、T3、T4、T5较T1升高(P＜0.01).G组T2 、T3、T4、T5较E组升高(P＜0.01);② PaCO2的变化: 2组T3、T4均较T1升高(P＜0.05),T5均较T1升高(P＜0.01),但组间比较差异无显著性(P＞0.05);③ 2组的pH、SpO2差异无显著性(P＞0.05);结论 硬膜外麻醉复合异丙酚靶控输注,可以用于手术时间在1 h以内的妇科腹腔镜手术,但术中要加强呼吸管理.
Objective To investigate the feasibility of epidural anesthesia with propofol pumped via target controlled infusion (TCI) in gynecologic laparoscopic operations. Methods 40 ASAⅠ-Ⅱ gynecologic patients to be operated on via laparoscope were divided randomly into epidural anesthesia group (group E) and general anesthesia group (group G)(n=20 each group). In group E, L1~2 epidural anesthesia was induced with 1.73% lidocaine carbonate to achieve a sensory level at T6. Fentanyl 0.1 mg iv was given before pneumoperitoneum; propofol 1-2 mg/L was pumped via TCI and stopped at the end of operation. In group G, general anesthesia was induced with midazolam 0.03 mg/kg etc; the trachea was cannulated; respiration was maintained during the operation with TV=8 ml/kg ,RR=12 bpm, I∶E=1∶2. 1%-2% isoflurane inhalation accompanied by dosed vecuronium and fentanyl was started to maintain the depth of anesthesia and stopped by the end of operation. Arterial blood gases, pH, MAP, HR and SpO2 were analysed at 5 time points, upon entering the operating room (T1), during pneumoperitoneum (T2), 10 min after pneumoperitoneum (T3), 20 minutes after pneumoperitoneum (T4) and at the end of operation (T5). Results ① PaO2 at T2 was significantly higher than that at T1 in group E (P<0.01), and so were those at T3, T4, T5 (P<0.05). PaO2 at T2, T3, T4, T5 were also higher than that at T1 in group G (P<0.01). PaO2 at T2, T3, T4 and T5 were significantly higher in group G than in group E (P<0.01). ② PaCO2 at T3, T4 and especially at T5, were higher than that at T1 in the 2 groups (P<0.05, P<0.01). But the PaCO2 at the same time points were similar in the 2 groups (P>0.05). ③ There were no differences in PH and SpO2 between the 2 group (P>0.05). Conlusion Epidural anesthesia with propofol pumped via TCI can be used in gynecologic laparoscopic operations to be finished in 1 hour. It is important to emphasize the management of respiration in the practice.
出处
《徐州医学院学报》
CAS
2007年第3期180-183,共4页
Acta Academiae Medicinae Xuzhou
关键词
硬膜外
靶控输注
异丙酚
麻醉
静脉
epidural
target controlled infusion
propofol
anesthesia, intravenous
