蛛网膜下腔阻滞麻醉-硬膜外联合麻醉在急诊下肢手术中的应用  

The application of combined spinal epidural anesthesia during the emergency surgery on the lower limb

作　　者：陈本军[1] 黄昌林[1] 

机构地区：[1]湖南省常德市第一人民医院麻醉科,415003

出　　处：《中国医师进修杂志》2008年第1期20-22,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 比较蛛网膜下腔阻滞麻醉-硬膜外联合麻醉（CSEA）和硬膜外麻醉（EA）在急诊下肢手术的临床效果。方法 急诊下肢手术患者40例，年龄18—70岁，ASAⅠ- Ⅲ级，随机分为CSEA组和EA组。每组20例。两组均行L3-4穿刺，CSEA组注入0．5％左旋布比卡因2—3ml，EA组注入1％利多卡因与0．375％左旋布比卡因合剂10～15ml，两组均向头端置入硬膜外导管，根据需要追加1％利多卡因与0．375％左旋布比卡因合剂6～8ml，使感觉阻滞平面不超过T10，比较两组麻醉起效时间，不良反应发生情况等。结果 CSEA组局麻药起效时间明显短于EA组（P〈0．01），两组恶心、呕吐发生率相似，两组均无一例发生术后头痛。结论 CSEA与EA均可用于急诊下肢手术的麻醉，但CSEA具有起效快、阻滞完善、能迅速解除患者疼痛等优点，更有利于急诊手术，值得临床推广使用。Objective To compare the clinical effect of combined spinal epidural anesthesia （CSEA） with that of epidural anesthesia （EA） during the emergency surgery on the lower limb. Methods Forty patients underwent the emergency surgery on the lower limb were divided into 2 groups randomly, whose ages extented from 18 to 70 years, ASA Ⅰ - Ⅲ, so each group contained 20 cases averagely, and both two groups puctured L3-4. Injected 2-3 ml of levobupivacaine into the CSEA group while injected 10-15 ml of 1% lidocaine and 0.375% levobupivacaine into the EA group . Two groups were posted epidural catheter to the top,and then,to make the felling block plane not more than T10,increased 6-8 ml of 1% lidocaine and 0.375% levobupivacaine according to the need, then compared the anesthetic onset time and side effect＇s occurance of the two groups, and so on. Results The anesthetic onset time of CSEA group was obviously less than that of EA group （P〈 0.01 ） ,but the nausea and vomiting probability of the two groups was rather simi- lar. In addition,none of the two groups＇ patients had got a headache after operation. Conclusions Both CSEA and EA can be applied in the emergency surgery on the lower limb, nevertheness, CSEA gets effective and consummate, which can relieve sufferers＇ pain quickly, and most importantly, it is more contribute to emergency surgery .Therefore, CSEA deserves being promoted and widely used in clinical medicine.

关 键 词：急诊处理 麻醉 硬膜外 

分 类 号：R614[医药卫生—麻醉学]