CAJ | 학술논문

【目的】探讨全身麻醉复合硬膜外阻滞在高血压患者阴式子宫切除术中的应用效果。【方法】将60例择期行阴式子宫切除术的高血压患者随机分为全身麻醉复合硬膜外阻滞组（A组）和单纯全麻组（B组）两组。A组术后采用硬膜外自控镇痛（PCEA ）方式镇痛，B组术后采用经静脉自控镇痛（PCIA ）方式镇痛。分别于麻醉前（T0），气管插管1 min后（T1），手术开始3 min后（T2），切除子宫后（T3），清醒拔管后（T4）记录心率（HR）、收缩压（SBP）以及舒张压（DBP）的变化，并观察术中肌松效果，全麻镇静镇痛药用量、术毕自主呼吸恢复及清醒拔管时间。并且比较两组术后镇痛的患者满意度。【结果】 B组患者在 T2，T3，T4时的 HR、SBP、DBP均明显高于A组（ P ＜0．05）；A组的丙泊酚、芬太尼、维库溴铵剂量明显低于B组（ P ＜0．05）；A组患者术毕自主呼吸恢复时间，完全清醒拔管时间也明显短于B组（ P ＜0．05）；A组患者术后镇痛满意度评价高于B组（ P＜0．05）。【结论】全身麻醉复合硬膜外阻滞能有效减少高血压患者阴式子宫切除术中应激反应、其血流动力学稳定，镇痛与肌松完善，术毕清醒拔管快，术后镇痛满意度高，是此类患者手术比较安全有效的麻醉方法。
【목적】탐토전신마취복합경막외조체재고혈압환자음식자궁절제술중적응용효과。【방법】장60례택기행음식자궁절제술적고혈압환자수궤분위전신마취복합경막외조체조（A조）화단순전마조（B조）량조。A조술후채용경막외자공진통（PCEA ）방식진통，B조술후채용경정맥자공진통（PCIA ）방식진통。분별우마취전（T0），기관삽관1 min후（T1），수술개시3 min후（T2），절제자궁후（T3），청성발관후（T4）기록심솔（HR）、수축압（SBP）이급서장압（DBP）적변화，병관찰술중기송효과，전마진정진통약용량、술필자주호흡회복급청성발관시간。병차비교량조술후진통적환자만의도。【결과】 B조환자재 T2，T3，T4시적 HR、SBP、DBP균명현고우A조（ P ＜0．05）；A조적병박분、분태니、유고추안제량명현저우B조（ P ＜0．05）；A조환자술필자주호흡회복시간，완전청성발관시간야명현단우B조（ P ＜0．05）；A조환자술후진통만의도평개고우B조（ P＜0．05）。【결론】전신마취복합경막외조체능유효감소고혈압환자음식자궁절제술중응격반응、기혈류동역학은정，진통여기송완선，술필청성발관쾌，술후진통만의도고，시차류환자수술비교안전유효적마취방법。
[Objective] To explore the efficacy of general plus epidural block anesthesia in hypertensive pa‐tients undergoing vaginal hysterectomy .[Methods] A total of 60 hypertensive patients undergoing vaginal hysterectomy were recruited and divided randomly into two groups ( n=30 each) .Group A received intrave‐nous plus epidural anesthesia while intravenous anesthesia was offered in group B .The values of heart rate (HR) ,systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at different anesthetic stages (T0 ~T4 ,T0 :pre‐anesthesia ,T1 :1 min post‐intubation ,T2 :3 min after start of operation ,T3 :after removal of uterus and T4 :awake extubation) .And comparisons were made for muscle relaxing effect ,volume of narcotic drugs ,operative period of the end to wake up under normal circumstances and postoperative analge‐sia effect (PCEA for group A and PCIA for group B) .[Results] There were significant higher levels of HR , SBP and DBP in group B than in those group A during anesthetic stages T2 ~T4 ( P<0 .05) .The volumes of propofol ,fentanyl and muscle relaxant (vecuronium bromide) were less in group A than those in group B ( P<0 .05) .There were also other advantages of time for spontaneous breathing recovery postoperatively ,awake extubation time and satisfaction evaluation in group A compared to group B ( P <0 .05) .[Conclusion] Intra‐venous plus epidural anesthesia can reduce intraoperative stress response ,make hemodynamic stable ,reduce the doses of general anesthetics and muscle relaxant and achieve patient satisfaction by the perfect effect of an‐algesia ,muscle relaxation ,fast postoperative extubation and epidural postoperative analgesia effects .