硬膜外腔注药对腰硬联合麻醉中腰麻平面的影响研究被引量：4

Study on the Impact of Epidural Injection on Spinal Anesthesia Level during Combined Spinal-Epidural Anesthesia

下载PDF

导出

摘要目的比较在硬膜外腔注入生理盐水和利多卡因对腰硬联合麻醉(CSEA)中腰麻平面的影响。方法选取我院2016年11月至2017年3月在CSEA下手术的60例患者,随机分为观察组和对照组各30例。观察组在硬膜外腔注入生理盐水,对照组在硬膜外腔注入利多卡因。两组各均分为5 m L、10 m L和15 m L三组剂量。各组均在腰麻平面固定后给药,检测各组给药后的最高麻醉平面,对比各组对麻醉平面的影响。结果观察组和对照组的腰麻平面均有不同程度的升高。注入5 m L溶液后,麻醉平面较基础平面升高约0.8个脊髓节段(P<0.05);注入10 m L与15 m L溶液后,麻醉平面较基础平面升高约2个脊髓节段(P<0.01);除15 m L组外,注射同剂量生理盐水和利多卡因的麻醉平面比较差异无统计学意义(P>0.05)。结论 CSEA时将生理盐水注入硬膜外腔可提高腰麻平面,其效力与等容量利多卡因相当,其机制为容量效应。 Objective To compare the impact of normal saline and lidocaine for epidural injection on spinal anesthesia level during combined spinal-epidural anesthesia （CSEA）. Methods 60 cases of patients with surgery under CSEA in our hospital from November 2016 to March 2017 were selected and randomly divided into observation group and control group, with 30 cases in each group. The observation group received normal saline for epidural injection, while the control group received lidocaine for epidural injection. Both groups were equally divided into three subgroups with dosage of 5 mL, 10 mL and 15 mL. Drugs were injected after the fixation of spinal anesthesia level in all groups. Then the highest anesthesia level was detected and the impact of different subgroups on anesthesia level was compared and analyzed. Results The spinal anesthesia levels of observation group and control group increased in different degrees. After injecting 5 mL solution, the anesthesia level was improved about 0.8 segment of spinal cord compared with basic level （P〈0.05）. After injecting 10 mL and 15 mL solutions, the anesthesia level was improved about 2 segments of spinal cord compared with basic level （P 〈0.01）. Except the subgroup of 15 mL, no statistical difference was found in the anesthesia level after injecting the same dose of normal saline and lidocaine （P 〉0.05）. Conclusions The spinal anesthesia level can increase when the normal saline is injected to epidural cavity during CSEA. The normal saline has the same effect as isometric lidocaine. The mechanism is proved to be capacity effect.

作者胡小福张卫军官海燕

机构地区广东省翁源县人民医院麻醉科

出处《临床医学工程》 2017年第11期1557-1558,共2页 Clinical Medicine & Engineering

关键词生理盐水利多卡因腰硬联合麻醉硬膜外腔腰麻平面 Normal saline Lidocaine Combined spinal-epidural anesthesia Epidural cavity Spinal anesthesia level

分类号 R614 [医药卫生—麻醉学]

引文网络
相关文献

参考文献3

1张瑶,沈晓凤,冯善武,李彩娟,朱运河,王楠,徐世琴.硬膜外预注不同容量生理盐水减少硬膜外导管误入血管的效果[J].临床麻醉学杂志,2016,32(3):293-294. 被引量：6
2茹居平,李亚宁.硬膜外预充生理盐水预防剖宫产术中硬膜外置管诱发血管损伤的临床观察[J].临床麻醉学杂志,2014,30(8):820-821. 被引量：14
3朱泽峰,吴艳.硬膜外预注液预防置管并发症对剖宫产腰硬联合麻醉效果的影响[J].中华全科医学,2015,13(7):1106-1107. 被引量：14

二级参考文献19

1Harney D,Moran CA,Whitty R,et al.Influence of posture on the incidence of vein cannulation during epidural catheter placement.Eur J Anaesthsiol,2005,22 (2):103-106.
2Mhyre JM,Greenfield ML,Tsen LC,et al.A systematic review of randomized controlled trials that evaluate strategies to avoid epidural vein cannulation during obstetric epidural catheter placement.Anesth Analg,2009,108(4):1232-1242.
3Kim SY, Kim YY, Kim AR. Incidence of intravascular insertion in tho- racic epidural catheterization by using real time fluoroscopy[ J]. Kore- an J Anesthesiol,2012,62(3) :251-255.
4Han C, Zhou Q, Ding Z, et al. Effects of epinephrine in the epidural space on the incidence of blood vessel injury by epidural catheter in- sertion for cesarean section: a prospective, randomized, double-blind study [ J ]. J Clin Anesth ,2015,27 ( 1 ) :7-11.
5Geng G, Sun X, Huang S. Effect of preloading epidural space with nor- mal saline on the incidence of complications of epidural catheter place- ment and spinal anesthesia for cesarean section [ J ]. J Clin Monit Corn- put,2014,28 (3) :265-268.
6Loubert C, O' Brien PJ, Fernando R, et al. Epidm-al volume extension in combined spinal epidural anaesthesia for elective caesarean section : a randomised controlled trial[J]. Anaesthesia,2011,66(5) :341-347.
7Higuchi H,Takagi S, Onuki E, et al. Distribution of epidural saline up- on injection and the epidural volume effect in pregnant women [ J ]. Anesthesiology ,2011,114 (5) : 1155-1161.
8Lechner TJ,van Wijk MG,Jongenelis AA,et al. The use of a sound- enabled device to measure pressure during insertion of an epidural catheter in women in labour [ J ]. Anaesthesia, 2011,66 ( 7 ) : 568- 573.
9Sviggum HP, Farber MK. The incidence and management of inability to advance Arrow FlexTip Plus epidural catheters in obstetric patients [J]. Int J Obstet Anesth,2014,23(2) :113-117.
10Han CB, Yu L, Qian YN, et al. Effects of predistention with normal saline containing adrenaline on blood-vessel injury during epidural catheter placement [ J ]. J Int Med Res,2011,39 ( 6 ) :2302-2306.