摘要
目的评价硬膜外腔预充0．9％氯化钠对剖宫产术患者置管诱发硬膜外血管损伤的影响。方法选择单胎足月妊娠拟行子宫下段剖宫产术的患者100例，ASA分级Ⅰ～Ⅱ级，按随机数字表法分为预充0．9％氯化钠组（P组）和直接置入硬膜外导管组（c组），每组50例。硬膜外穿刺成功后，P组经硬膜外穿刺针注入0．9％氯化钠5ml，注射完后保持注射器压缩针栓20S，使预充液充分扩散；C组直接置入硬膜外导管。记录麻醉前、穿刺置管成功后改仰卧位2min、胎儿娩出和手术结束时的平均动脉压和心率；记录置人硬膜外导管时硬膜外穿刺针针尾见淡红色血水、硬膜外导管回抽出淡红色血水、硬膜外导管置入血管和拔出硬膜外导管见尾端有暗红色血的例数。结果两组血流动力学指标均波动在正常范围，两组术中各时间点平均动脉压及心率比较差异无统计学意义（P〉0．05）。P组硬外穿刺针针尾见淡红色血水的发生率低于C组[10％（5／50）比26％（13／50），P〈0．05]，拔出硬膜外导管见尾端有暗红色血的发生率也低于C组[22％（11／50）比48％（24／50），P〈0．01]。结论硬膜外腔预充0．9％氯化钠5ml可有效减少置管对硬膜外血管的损伤。
Objective To evaluate the effect of preloading epidural space with 0.9% sodium chloride on the incidence of the injury to blood vessel by epidural catheter insertion for cesarean section.Methods One hundred uterogestation patients with single birth,ASA class Ⅰ - Ⅱ ,underwent caesarean section and requested continuous epidural analgesia were divided into group P and group C with each 50 cases by random digits table. After identification of the epidural space, group C was inserted epidural catheter directly,and 5 ml of 0.9% sodium chloride was injected into epidural space through the epidural needle in group P, while the syringe plunger was held closed for 20 s to make sure the solution spreaded sufficiently, following insertion the epidural catheter. Between the two groups, mean arterial pressure and heart rate were recorded prior to anesthesia, 2 min after turn to the supine horizontal position after succeeded puncture, the time when the fetus were born and when the surgery were over. The cases with bloody fluid in the epidural puncture needle during puncture, or in the epidural catheter during catheter placement, fresh blood in the epidural catheter,and bloody fluid in caudal end of epidural catheter during extubation were recorded. Results The changes of mean arterial pressure and heart rate were all in the normal range, there was no obvious difference between the two groups. The incidence of rates with bloody fluid in the epidural puncture needle during puncture and the bloody fluid in caudal end of epidural catheter during extubation in group P were significantly lower than those in group C [ 10%（5/50） vs. 26%（13/50） ,22%（11/50） vs. 48%（24/50）, P 〈 0.05 or 〈 0.01 ]. Conclusion Preloading epidural space with 5 ml 0.9% sodium chloride can reduce the incidence of the injury to blood vessel induced by insertion of epidural catheter.
出处
《中国医师进修杂志》
2012年第24期27-29,共3页
Chinese Journal of Postgraduates of Medicine
关键词
氯化钠
麻醉药
局部
硬膜外腔
血肿
剖宫产术
Sodium chloride
Anesthetics, local
Epidural space
Hematoma
Cesarean section
