Spinocath 导管连续蛛网膜下隙阻滞在老年妇科肿瘤手术麻醉中的应用
【摘要】 目的 比较连续腰麻(CSA)、腰-硬联合麻醉(CSEA)用于高龄妇科肿瘤手术患者的临
床效应。方法 择期妇科恶性肿瘤实施开腹广泛全子宫切除并盆腔淋巴清扫手术的患者 60
例 , 年 龄 70 ~ 78 岁 , ASAⅡ
~ Ⅳ 级 , 分 为 CSA 组 (Ⅰ 组 , n=30) 和 CSEA(Ⅱ 组 ,
n=30) 。CSEA 组于 L3~4 间隙蛛网膜下腔注入 0.5% 布比卡因 5.5~7.5 mg,硬膜外用药一
次 2% 利多卡因 2~6 ml,麻醉平面不够或时间超过 60 min 再追加 2% 利多卡因 2~4
ml 。CSA 组采用 Spinocath 导管针,于 L3~4 间隙穿刺,蛛网膜下腔置管 2 cm,首次剂量
0.5% 布比卡因 5.0~6.5 mg,手术 90 min 后追加 3.0~5.0 mg。比较两组的阻滞平面、镇痛
效果、肌松程度,循环变化及术后并发症等情况。结果 以上两组在麻醉阻滞平面、镇痛效
果、肌松程度。循环变化情况差异有统计学意义(P<0.05)
。结论 Spinocath 连续腰麻用于老年
患者,特别是施行妇科盆腔手术时,麻醉效果满意,肌松完全,对呼吸、循环系统干扰小,
麻醉并发症少,是一种理想的麻醉方法。
【关键词】 连续腰麻;妇科肿瘤;Spinocath 导管
Application of Spinocath catheter continuous spinal anesthesia in the surgery of elderly
gynecological malignant tumor
FANG Man-jing,LUO Li-bing,CHANG Jun,et al.Maternal and Child Health Hospital
of Nanshan,Shenzhen 518052,China
[Abstract] Objective To compare the clinical effect of continuous spinal
anesthesia(CSA) , spinal and epidural anesthesia(CSEA)for elderly patients with gynecological
malignant tumor.Method For selective implementation of the abdominal gynecological
malignancies extensive hysterectomy and pelvic lymph node dissection in patients with patients
60 cases , 70 ~ 78 years old , ASA Ⅱ
~ Ⅳ grade were divided into CSA group(Ⅰ
group,n=30)and CsEA( group
Ⅱ
,n=30).To investigate the effectiveness of the application of the
continuous spinal anesthesia in the operation of gynecologic malignant tumors.Methods 90 cases
of gynecologic malignancies because of the implementation of extensive abdominal hysterectomy
and pelvic lymph node dissection patients were randomly divided into two groups , combined
spinal and epidural anesthesia(CSEA group , n=30) , continuous spinal anesthesia group(CSA
group,n=30).CSEA group nere with L3~4 space subarachnoid injection of 0.5% bupivacaine
5.5~7.5 mg,a 2% lidocaine epidural medication 2~6 ml,anesthesia is not enough,or more
than 60 min and then didan additional 2% lidocaine 2~4 ml.CSA group were Spinocath catheter
needle , at the L3 ~ 4 space puncture , subarachnoid catheter 2 cm , the first dose of 0.5%
bupivacaine was 5.0 ~ 6.5 mg , an additional was 3.0
~ 5.0 mg after 90 minutes of
surgery.Compared the block plane,analgesic effect,degree of muscle relaxation,circulation
changes and postoperative complications and so on in two groups.Results The block plane
analgesic effect , degree of muscle relaxation , circulation changes in two groups all had all
significant differences(P<0.05).Conclusion Spinocath continuous spinal anesthesia for elderly
patients , especially the implementation of gynecological pelvic surgery , has the effect of
anesthesia which is satisfactory,muscle relaxation is complete,the disturbance to respiratory
and circulatory is small,complications of anesthesia is few.CSA is an ideal method of anesthesia.