摘要
目的比较丙泊酚复合芬太尼辅助硬膜外麻醉与氯胺酮复合咪唑安定辅助硬膜外麻醉在妇科腹腔镜手术的应用。方法选择ASAⅠ～Ⅱ级心肺功能正常100例妇科腹腔镜下非全子宫切除术病人，随机分为两组，每组50例。对照组K组，氯胺酮复合咪唑安定组，实验室P组，丙泊酚复合芬太尼组。两组均选L1-2间隙施行连续硬膜外麻醉，试验剂量为2％利多卡因5ml，首次剂量为1％罗哌卡因10～15ml，控制硬膜外阻滞平面在T8～S4，两组患者均于气腹前、气腹后15min和气腹后30min均记录平均动脉压（MAP）、心率（HR）、呼吸频率（f）、血氧饱和度（SPO2）、呼气末二氧化碳分压（PET，CO2）和潮气量（VT）同时记录两组患者术后头晕、头痛、恶心、呕吐等不良反应发生率。结果K组患者HR于气腹后15min明显升高，P〈0．01，VT于气腹后15min明显下降，P〈0．05，f和PET，CO2于气腹后15min、气腹后30min明显升高，P〈0．01。P组患者MAP于气腹后15min、30min明显下降，P分别〈0．05和〈0．01，HR于气腹后15min、30min明显下降，P〈0．01；VT于气腹后15min也下降，P〈0．05，f和PET CO2于气腹后15min、30min均明显升高，P〈0．01。与K组比较，P组患者MAP、HR于气腹后15min、30min明显低于K组，P〈0．01；P组患者PET CO2于气腹后15min明显高于K组，P〈0．05。与K组相比，P组不良反应发生率明显低于K组。结论丙泊酚复合芬太尼辅助硬膜麻醉。
Objective To compare the result of applying propofol and fentanyl compound as assistant epidural anesthesia with application of ketamine and midazolam compound as assistant epidural anesthesia in laparoscopic surgery. Methods Chose 100 cases of women with ASA Ⅰ - Ⅱ level of normal cardiac and pulmonic function for laparoscopic surgery, and divided them in two groups, 50 persons each. The comparative Group K was applied with ketamine and midazolam compound; while the experimental group P was applied with propofol and fentanyl compound. Both groups chose L1-2 gap to apply continuous epidural anesthetics, the experimental dose was 5ml 2% lidocaine; and the first dose was 10 - 15ml 1% ropivacaine, controlling epidural retardarce complanation at T8 -S4. Recorded the average mean arterial blood pressure （MAP）, heartbeat rate （HR）, aspiratory frequency, oxygen saturation SPO2, PET CO2 and tidal volume （VT） 15 minutes before and after aeroperitoneum occurrence. Meanwhile recorded ill reaction rate of swirl, headache, naupathia, queasiness and vomit occurring on patients in the two groups. Results The heartbeat rate （HR） in Group K rose distinctly 15 minutes after aeroperitoneum, P 〈 0.01 ; tidal volume VT declined distinctly 15 minutes after aeroperitoneum , P 〈 0.05 ; the aspiratory frequency （f） and PET CO2 rose distinctly 15 minutes and 30 minutes after aeroperitoneum, P 〈 0.01. The MAP of patients in Group P declined evidently 15 minutes and 30 minutes after aeroperitoneum, P 〈0.05 and 0.01; the HR declined evidently 15 minutes and 30 minutes after aeroperitoneum, P 〈0.01 ; the tidal volume VT also declined, P 〈0.05 ; the aspiratory frequency （f） and PET CO2 rose distinctly 15 minutes and 30 minutes after aeroperotoneum, P 〈 0.01. Compared with Group K, MAP and HR of patients in Group P were obviously lower 15 and 30 minutes after aeroperitoneum, P 〈0.01 ; the PET CO2 of patients in Group P were evidently higher than that of patients in Group K 15 minutes after aeroperitone
关键词
丙泊酚
芬太尼
硬膜外麻醉
妇科
腹腔镜手术
Propofol Fentanyl Epidural anesthesia Gynaecology Laparoscopic surgery
