复方利多卡因乳膏对宫腔镜手术麻醉的影响

Effect of lidocaine-prilocaine cream on anesthesia of hysteroscopy

摘要:

目的  观察复方利多卡因乳膏（EMLA）应用于宫腔镜手术的麻醉效果。方法  择期将60例宫腔镜手术患者随机均分为对照组（Ⅰ组）和复方利多卡因组（Ⅱ组）；手术前7 min，于宫颈口和内腔各涂抹2.5 g超声导膏和EMLA；术者消毒时续贯推注芬太尼1.0μg/kg和丙泊酚1.5～2.5 mg/kg至睫毛反射消失，泵注丙泊酚4～6 mg/（kg·h）维持麻醉。观察T0、T1、T2及T3时MAP、HR、SpO2、BIS和丙泊酚总用量、术后VAS评分、手术时间、苏醒时间以及术中体动。结果  ①血流动力学：T2及T3时，Ⅰ组较Ⅱ组高（P <0.05）；麻醉开始后，Ⅰ组内T1最低（P <0.05）。②BIS：两组间比较差异无统计学意义；麻醉后，两组BIS都降低，但Ⅱ组中，T3较T2及T1高（P <0.05）。③其他：两组丙泊酚总用量、VAS、苏醒时间以及术中体动比较差异有统计学意义（P <0.05）。结论  在宫腔镜手术静脉麻醉中，局部应用EMLA能增强麻醉效果，有利于保持生命体征平稳及苏醒。

Abstract:

Objective To study the anesthesia efficacy of lidocaine-prilocaine [EMLA(R)] cream applied in hysteroscopic practice. Methods Sixty patients underwent selective hysteroscopy surgery were randomly divided into control group (groupⅠ), lidocaine-prilocaine [EMLA(R)] cream group (group Ⅱ). Seven minutes before surgery, 2.5 g ultrasound gel and EMLA were smeared endocervically and exocervically in group ⅠandⅡ respectively. When gynecologist sterilized, patients were inducted of anesthesia with 1 μg/kg fentanyl and 1.5-2.5 mg/kg propofol until eyelash reflex disappeared, and maintenance with propofol 4-6 mg/kg. The MAP, HR, SPO2 and BIS were recorded before anesthesia (T0), when consciousness loss (T1), when cervical dilatation (T2) and at the end of surgery (T3). Meanwhile total dosage of propofol, postoperative pain, intraoperative body movement, operation and recovery time were recorded. Results After induction, hemodynamics of groupⅠwere lower than Ⅱat T2 and T3, and the lowest occurred at T1 in group Ⅰ(P < 0 .05 ). BIS had no difference between group ⅠandⅡ, after anesthesia it fell, and in group Ⅱat T3 it was higher(P < 0.05 ). There were differences between the groups in dosage propofol, VAS, recovery time and intraoperative body movement (P < 0.05 ). Conclusions In intravenous anesthesia of hysteroscopic surgery, the EMLA can enhance anesthetic effect, shorten recovery time, help to maintain vital signs stable.