摘要
目的探讨硬膜外预充生理盐水预防剖宫产术患者硬膜外置管诱发血管损伤的适宜剂量。方法单胎足月妊娠拟在硬膜外麻醉下行子宫下段剖宫产术的患者200例，ASA分级Ⅰ或Ⅱ级，年龄24～35岁，体重63～78k只。采用随机数字表法，将患者随机分为4组（n=50）：Ⅰ组～Ⅳ组。硬膜外穿刺成功后，Ⅰ组直接置入硬膜外导管，Ⅱ组、Ⅲ组和Ⅳ组分别通过硬膜外针注射0．9％生理盐水2、5和10ml，注射完后保持注射器压缩针栓20s，使预充液充分扩散，然后置入硬膜外导管。注入1．5％利多卡因3ml，排除脊麻征象后，按需分次追加0．75％罗哌卡因10～20ml。于麻醉前（Tn）、硬膜外腔给药完毕后10min（T1）、20min（L）和手术结束时（L）记录MAP和HR；记录硬膜外穿刺针针尾见淡红色血水、硬膜外导管回抽见淡红色血水、硬膜外导管置入血管、拔出硬膜外导管见尾端有暗红色血液的发生情况及罗哌卡因用量；于T2时测定麻醉平面上界，并采用改良的Bromage分级评定双侧运动阻滞情况。结果4组血液动力学指标均波动在正常范围。与工组、Ⅱ组和Ⅲ组比较，Ⅳ组T2时MAP降低，麻醉平面上界升高，Bromage分级降低（P〈0．05），Ⅰ组、Ⅱ组和Ⅲ组间MAP差异无统计学意义（P〉0．05）。4组间HR和罗哌卡因用量比较差异无统计学意义（P〉0．05）。与Ⅰ组和Ⅱ组比较，Ⅲ组和Ⅳ组硬膜外穿刺针针尾见淡红色血水的发生率、硬膜外导管回抽出淡红色血水的发生率和硬膜外导管见尾端有暗红色血液的发生率降低（P〈0．05）。结论硬膜外预充5ml，生理盐水既能有效预防剖宫产术患者硬膜外置管诱发血管损伤，又不影响麻醉效果，是适宜剂量。
[Abstract] Objective To determine the optimum dose of normal saline （NS） for preloading epidural space required to prevent the injury to blood vessel by epidural catheter placement for caesarean section. Methods Two hundred ASA I or lI parturients with a single baby at full term in vertex presentation, aged 24-35 yr, weighing 63-78 kg, scheduled for caesarean section under continuous epidural anesthesia, were randomly divided into 4 groups （ n = 50 each） ： control group （group I ）, NS 2 ml group （group ]I ）, NS 5 ml group （group m ） and NS 10 ml group （group iV ）. The epidural puncture was performed at L2_3 interspace with a Tuohy needle at- tached to a 5 ml syringe. Loss of resistance was used to identify the epidural space. In group C no fluid was inject- ed into the epidural space before insertion of the catheter, while in groups lI , I[ and iV NS 2, 5 and 10 ml were injected into the epidural space before the catheter insertion respectively. After a test dose of 3 ml 1.5% lido- caine, 0.75% ropivacaine 10-20 ml was administered through the epidural catheter. MAP and HR were recorded before epidural puncture （TO ）, at 10 and 20 min after the end of epidural administration （T,.2）, and at the end of surgery （%）. The number of patients in whom blood or blood tinted fluid was withdrawn from the epidural catheter was recorded. The amount of ropivacaine consumed was recorded. The upper level of anesthesia was measured by pin-prick and the degree of motor block was assessed using modified Bromage scale at T2 . Results The hemody- namic parameters were in the normal range in the four groups. MAP was significantlY lower at T2, the upper level of anesthesia was significantly higher, and the degree of motor block was significtmtly smaller in group Ⅳ than in groups Ⅰ , Ⅱ and Ⅲ （ P 〈 0.05 ） . There was no significant difference in MAP among groups Ⅰ , Ⅱ and Ⅲ （ P 〉 0.05）. There was no significant difference in HR and the amount of ＂ropivacaine consumed among the four groups （ P 〉 0.05 ）. The number of patients in whom blood or blood tinted fluid was withdrawn from epidural cath- eter was significantly smaller in groups Ⅲ and Ⅳ compared with groups Ⅰ and Ⅱ（P 〈0.05）. Conclusion Preloading the epidural space with NS 5 ml can prevent the occurrence of injury to blood vessel induced by insertion of epidural catheter with no influence on the efficacy of aneathesia and NS 5 ml is the optimum dose.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2012年第8期929-932,共4页
Chinese Journal of Anesthesiology
关键词
氯化钠
注射
硬膜外
血肿
硬膜外
脊髓
剖宫产术
Sodium chloride
Injections, epidural
Hematoma, epidurat, spinal
Cesarean section
