腰麻在基层医院下腹部部分腹腔镜手术中的临床应用体会

摘要

目的 (1)腰麻应用于下腹部部分腹腔镜手术是可行性的.(2)有利于基层医院单病种限费和临床路径管理.(3)合理利用基层有限的医疗资源.方法 选取ASA评分Ⅰ~Ⅱ级的患者921例,经L2~3或L3~4间隙行腰麻,辅助蛛网膜下腔和静脉注射芬太尼等,行下腹部腹腔镜手术.结果 基层医院下腹部腹腔镜手术采用腰麻,术中SPO2维持在95%以上,肌松满意.结论 (1)腰麻辅助蛛网膜下腔注射芬太尼和静脉注射适量镇痛药,是安全可行的.(2)腰麻与全麻比较每例手术可节省费用900元左右,单病种限费和临床路径管理.%Objective (1)lumbar anesthesia was feasible for laparoscopic surgery in the lower abdomen. (2)it is advantageous for the single disease limit fee and the clinical route management in the primary hospital. (3)reasonable use of basic limited medical resources.Methods 921 patients with grade ASA were selected from grade Ⅰ to grade Ⅱ, and lumbar anesthesia was performed with L2~3 or L3~4, and fentanyl was assisted by subarachnoid space and intravenous fentanyl.Results The laparoscopic operation of the lower abdomen in the basic hospital was performed with lumbar anesthesia, and the SPO2 was maintained at 95% and the muscle relaxation was satisfactory.Conclusion (1)lumbar anesthesia with intravenous injection of fentanyl and intravenous administration of fentanyl is feasible and safe. (2)lumbar anesthesia and general anesthesia, compared with each case of surgery can save costs about 900 yuan, the single disease limits and clinical path management.