硬膜外两点法在阴式全子宫切除术麻醉应用.docVIP

硬膜外两点法在阴式全子宫切除术麻醉应用【摘要】 目的 硬膜外两点麻醉方法在阴式全子宫切除术中的应用。方法 40例阴式全子宫切除患者,全部采用L??1~2?椎间隙向头置管和L??3~4?椎间隙向尾置管的硬膜外两点麻醉方法。结果 硬膜外两点麻醉方法,具有肌肉、子宫韧带和宫颈松弛度优良,术中牵拉反应轻而少,局麻药维持时间长等优点。结论 硬膜外两点麻醉方法,用于阴式全子宫切除术,具有一定的临床应用价值。 【关键词】 硬膜外; 两点; 阴式;子宫切除 The realize of the both point anesthetic method of the epidural space used to negativeway hysterectomy CHENG Dianchen,LI Weidong.The Department of anesthetic of Womanchild Health Hospital of Lan Zhou City Lan Zhou Gan Su province 730030,China 【Abstract】 Objective To used to negative way hysterectomy with the both paint negative way method of the epidural space.Methods 40 patients of the negative way anesthetic hysterectomy,all were used to the both point anesthetic method of the epidural space,the small pipe was towards the head at the L??1~2?space and the small pipe was towards the tail at theL??3~4? space.Results The myometrium uterus ligaments and the cervix were good limp.It is merrier of the topical anesthetic has keeped longer time and the dragging pain has lighter and lesser effect in the operation.Conclusion It has certainly worth of the clinical used to about the both point anesthetic method of the epiduralspace used to negativewayhysterctomy. 【Key words】 Epiduralspace bothpain; Negativeway; Hysterectomy DOI:10.3760/cma.j.issn2010.01.117 作者单位:730030甘肃省兰州市妇幼保健院麻醉科 阴式子宫切除术具有腹部无瘢痕,手术损伤小,术中出血少,术后体温高峰降低,肠管干扰轻,术后排气早,进食早,住院时间短,不增加手术时间和医疗费用,提高了患者的生活质量,取得了良好的效果?[1]?。近年来,我院广泛开展了阴式全子宫切除这一微创手术,由于经阴道全子宫切除手术途经的特殊性,在麻醉方法选择上有不同的见解?[2]?,硬膜外一点和腰硬联合的麻醉方法。虽然这两种麻醉方法都有不错的临床效果,但硬膜外一点麻醉方法常难满足此手术要求,有时宫颈和子宫韧带松弛度差,术中牵拉反应重。腰硬联合麻醉,宫颈和子宫韧带松弛度较好,但术后有头痛(妇产科手术发生率为12%,女性多于男性?[3]?)、背痛(腰麻后引起腰脊部痛发生率为3%~5%?[4]?)和尿潴留的并发症。为达到最佳的临床麻醉效果,笔者应用硬膜外两点麻醉方法用于阴式全子宫切除术的麻醉,现报告如下。 1 资料与方法 40例阴式全子宫切除患者,年龄40~70岁,体重43~72 kg,身高145~167 cm。ASA分级为:III。麻醉前用药均为术前肌注安定10 mg,阿托品0.5 mg,术中均静脉辅以杜冷丁100 mg和氟哌利多5 mg半量合剂(静脉辅助药)。硬膜外腔穿刺点均为L??1~2?椎间隙向头置管3~4 cm(编号导管Ⅰ)和L??3~4?椎间隙向尾置管3~4 cm(编号导管Ⅱ)。硬膜外穿刺、置管顺利成功后,常规开放静脉通道补液维持患者正常生理机能,患者均为膀胱截石位。先予导管Ⅰ注入2%利多卡因试验量3 ml,观察5 min