摘要
为了探讨单次硬膜外麻醉在肛肠疾病手术中的应用，云南省老年病医院麻醉科采用单次硬膜外麻醉方法与低位连续硬膜外麻醉方法行肛周手术，比较其两种麻醉方法的临床麻醉效果。将肛周疾病患者50例，随机分为2组，每组各25例。I组采用单次硬膜外麻醉，Ⅱ组采用连续硬膜外麻醉。I组采取坐姿弓腰体位行硬膜外穿刺，选择L3／4以下明显的椎间隙穿刺成功后，回吸无血液或脑脊液后，给予1％利多卡因5mL试验剂量，观察无脊髓麻醉现象和特殊不适后，缓慢分次推注15mL混合药液（1％利多卡因加0．25％布比卡因混合液），扶好患者保持坐姿1-2min，然后侧卧或截石卧位调整摆放好手术体位。Ⅱ组侧卧位选择L3／4以下明显的椎间隙穿刺成功后，置入硬膜外导管，置管方向以向下首选，当置管受阻不畅时，改向头侧置管，麻醉诱导及给药方法和剂量完全同I组。结果显示，I组单次硬膜外麻醉组麻醉效果好，起效时间快，镇痛完善，肌松好，有效率高，对呼吸、循环影响轻微，各项生命体征平稳。优于Ⅱ组连续硬膜外组。结果表明，肛周常见疾病手术常用骶管麻醉穿刺困难或麻醉效果失败时，单次硬膜外麻醉方法效果确切，起效快，药量少，镇痛完善，肌松好，有效率高，对双下肢运动神经阻滞轻微，对呼吸、循环影响轻微，各项生命体征平稳，不失为一种理想的麻醉选择方法。
In this study authors hospital anesthesia department applied single-time method of epidural an- esthesia and low continuous method of epidural anesthesia in anorectal disease surgery,and compared both methods efficacy,so as to explore the application of single-time epidura anesthesia in surgery of anorectal disease;divided 50 patients with perianal diseases randomly into group I and II ,25 cases for each,group I and II adopted above two anesthesia methods respectively.In group I, the epidural puncture was per- formed on bent sitting posistion.After puncture success of below L3/4 obvious intervertebral space and re- turning suction there was no blood or cerebrospinal fluid,gave 5 mL 1% lidocaine（the trail dosage）. After observing no rachianalgesia and special discomfort, 15 mL of mixed liquid （1% lidocaine plus 0.25% bupi- vacaine mixture） was fractional injected slowly, and help patient to keep sitting 1 to 2 min, and then lie on the side or lithotomy position to adjust the surgery position.In group II ,taking lateral position and after puncture success of intervertebral space on L3/4, epidural catheter was inserted,and the best orientation was downward, when the catheter is blocked,convert the catheterto the head.And anesthesia induction and the method ＆ dosage of administration was same as group I .As results, the single-time method used in group I had good efficacy,fast onset of action,complete analgesia,better muscle relaxation,high effective rate, less impact on patients respiration and circulation, thus all patients vital signs kept stable, which were superior to those in group II .Results show that if difficult to make paracentesis during caudal anesthesia or anesthesia efficacy failed,performing above single-time method of epidral anesthesia can achieve certain ef- ficacy, and its onset of action is fast, of less use of drug, complete analgesia, good muscle relaxation out- come,high effective rate,And,it influences slightly on blocking bilateral lower extremities motor nerves, and less impact on respiration and circulation,thus lets patient＇s all vital signs stable,therefore it just is ide- al choice of anethesia.
出处
《中国肛肠病杂志》
2017年第3期45-47,共3页
Chinese Journal of Coloproctology
关键词
单次硬膜外麻醉
肛周手术
效果观察
Single-time epidural anethesia
Perianal surgery
Effect observation
