利多卡因局部浸潤對異丙酚靶控輸注行宮頸錐切手術(shù)效果的影響.pdf

1、●k、利多卡因局部浸潤對異丙酚靶控輸注行宮頸錐切手術(shù)效果的影響摘要目的通過比較利多卡因局部浸潤復(fù)合異丙酚或單用異丙酚靶控l輸注靜脈麻醉的效果，探討利多卡因局部浸潤在宮頸錐切手術(shù)中的作用。方法擇期行宮頸錐切手術(shù)患者50例，年齡2555歲，體重4570kg，體重指數(shù)21～25kg／m2，ASAI或II級，采用隨機雙盲對照設(shè)計，分為2組(n=25)：復(fù)合利多卡因局麻組(LP組)宮頸周圍阻滯浸潤20mll％利多卡因(內(nèi)含1：40萬腎上腺素)，對

2、照組(P組)宮頸周圍阻滯浸潤20ml生理鹽水(內(nèi)含1：40萬腎上腺素)。所有患者在麻醉前30min肌注苯巴比妥鈉019，東莨菪堿03mg，入室后連接監(jiān)護儀，監(jiān)NECG、NBP、RR、SpO。及BIS。在手術(shù)開始前6min分兩次靜注芬太尼1IJg／kg，手術(shù)開始前3min啟動異丙酚靶控輸注，起始濃度為3ug／ml，依據(jù)O從／S鎮(zhèn)靜評分，宮頸松弛度調(diào)整異丙酚的靶濃度(每次03|lg／m1)，維持O從／S鎮(zhèn)靜評分在2分，病人無體動反應(yīng)。手術(shù)結(jié)

3、束前5min停止靶控輸注。手術(shù)全程保持患者自主呼吸，面罩吸氧(氧流量3L／min)，如出現(xiàn)呼吸抑制(舌后墜阻塞通氣道或呼吸頻率小于10次／分，SpO：小于95)，則給予托下頜、放通氣道改善通氣或面罩加壓通氣至SpO。大于95。于麻醉誘導(dǎo)前即刻(T。)、手術(shù)開始(T。)、手術(shù)lOmin(T。)、手術(shù)20min(T。)、手術(shù)結(jié)束(T。)、呼之睜眼(T。)以及離室(T。)記錄HR、SBP、DBP、MAP、RR、Sp02、BIS和TCI泵顯示的

4、異丙酚效應(yīng)室濃度，同時記錄手術(shù)時間、藥物Influenceoflocalinfiltrationoflidocaine011theeffectoftargetcontrolledinfusionofpropofolinconizationofcervixAbstractObjectiveToinvestigatetheinfluenceoflocalinfiltrationoflidocaineinconizationofcervixb

5、ycomparinglocalinfiltrationoflidocainecombinedtargetcontrolledinfusionofpropofolandtargetcontrolledinfusionofpropofolonlyMethodsFi姆ASAIorIIpatients(age25～55，weight45～70k，BMI21～25kg／m2)，scheduledforelectiveconizationofcer

6、vix，wererandomlydoubleblindlydividedintotwogroups(n=25)：lidocainelocalanesthesiagroup(groupLP)wereinfiltratedaroundcervixwith20mlof1％lidocaineincluding1：400000adnephrin；controlgroup(groupP)wereinfiltratedaroundcervixwith

7、20mlofnormalsalineincluding1：400000adnephrinonlyAllthepatientswerepremedicatedwithintramuscularPhenobarbitalsodiumO19andscopolamine03mg30minbeforeanesthesiaECG，NBP，RRSp02andBISwerecontinuouslymoniteredBothtwogroupsweretw

8、iceivfentanylofltg／kg6minbeforetheoperationTheTCIofpropofolwasstarted3minbeforetheoperationandtheinitialtargetconcentrationofpropofolWassetat30mg／L，settingthetargetconcentrationofpropofol(O3pg／mlpertime)tomaintainOAA／Sse

9、dationscoreat2TheTCIWasstoppedat5minbeforetheendoftheoperationDuringtheoperation，allpatientshadspontaneouslybreathingandoxygeninspiredwithfacemask(oxygenflow3L／min)Ifrespiratorydepressionhappened(SP0295)，supportingsubmax

10、illaparichnosandfacemaskpressurizeventingweregiventoassistrespiration，keepingSp02exceeding95HRSBP，DBP，MAP，RR，Sp02，BISandtargeteffectivesiteconcentrationofpropofolTClwererecordedimmediatelybeforeanestheticinduction(To)，im

11、mediatelybeforetheoperation(T1)，at10and20minafterthebeginningofoperation(T2，T3)，attheendofoperation(T4)，whenthepatientsregainedconsciousness(T5)，andwhenthepatientsleft(T6)Thetotalamountofpropofol，theincidenceofrespirator