利多卡因局部浸潤對異丙酚靶控輸注行宮頸錐切手術效果的影響.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效果的影響摘要目的通過比較利多卡因局部浸潤復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中的作用。方法擇期行宮頸錐切手術患者50例，年齡2555歲，體重4570kg，體重指數21～25kg／m2，ASAI或II級，采用隨機雙盲對照設計，分為2組(n=25)：復合利多卡因局麻組(LP組)宮頸周圍阻滯浸潤20mll％利多卡因(內含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。在手術開始前6min分兩次靜注芬太尼1IJg／kg，手術開始前3min啟動異丙酚靶控輸注，起始濃度為3ug／ml，依據O從／S鎮(zhèn)靜評分，宮頸松弛度調整異丙酚的靶濃度(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。手術結

3、束前5min停止靶控輸注。手術全程保持患者自主呼吸，面罩吸氧(氧流量3L／min)，如出現呼吸抑制(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。于麻醉誘導前即刻(T。)、手術開始(T。)、手術lOmin(T。)、手術20min(T。)、手術結束(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、異丙酚效應室濃度，同時記錄手術時間、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