两点穿刺腰硬联合麻醉在盆腔手术中的临床应用  

Combined spinal-epidural anesthesia by two-point punctures for pelvic surgery operation

作　　者：孙建斌[1] 赵新春[1] 陆阳春[1] 程海涛[1] 柳水平 陈玲利 

机构地区：[1]湖北省黄冈市黄州区人民医院麻醉科,湖北黄冈438000

出　　处：《中国医药导报》2010年第28期68-69,共2页China Medical Herald

摘　　要：目的:比较两点穿刺腰硬联合麻醉和单点穿刺腰硬联合麻醉的临床应用情况。方法:选择盆腔手术160例,随机分为两点穿刺组(A组)80例和单点穿刺组(B组)80例。A组选取T12～L1或L1～2脊间隙行硬膜外腔穿刺,置入硬膜外麻醉导管,然后选取L2～3脊间隙行蛛网膜下腔阻滞。B组选取L2～3脊间隙行硬膜外腔穿刺,硬膜外穿刺成功后,脊麻针经硬膜外穿刺针内进入行蛛网膜下腔麻醉,然后拔除脊麻针,再经硬膜外穿刺针置入导管。观察两组患者的椎管内穿刺及麻醉平面控制情况等。结果:A组无硬膜穿破,脊穿针顺利穿入蛛网膜下腔79例,穿不到脑脊液1例。B组脊穿针顺利穿入蛛网膜下腔72例,穿不到脑脊液8例,退脊麻针时硬膜穿破6例。麻醉平面情况:A组75例麻醉平面达到手术要求,4例麻醉平面过低,经过硬膜外追加局麻药达到手术要求。B组68例麻醉平面达到手术要求,10例麻醉平面过低,经过硬膜外追加局麻药4例达到手术要求。9例改全身麻醉完成手术。结论:两点穿刺腰硬联合麻醉方法完全避免了硬膜外针引导时穿破硬膜的风险,麻醉平面得到了理想的控制。Objective： To compare the clinical application of two methods in combined spinal-epidural anesthesia by two-point punctures and single-point. Methods： 160 cases with pelvic cavity surgery operations were randomly divided into two-point group （group A, n=80） and single-point group （group B, n=80）. Group A, the puncture point was located between T12-L1 or L1-2 and inserted the segmental epidural catheter, performed subarachnoid block between L2-3. Group B, the puncture point was located between L2-3, then inserted the segmental epidural catheter after the spinal anesthetic needle was pulled out. The puncturation and anaesthetic level were observed. Results： The status of puncturations： Group A, 79 cases＇ spinal anesthetic needles were successfully punctured in SAS and 1 case failed. Group B, 72 cases inserted SAS successfully and 8 cases failed. 6 cases with scleromeninx perforation during withdrawing the spinal anesthetic needle. The status of anaesthetic level： Group A, The anaesthetic level of 75 cases achieved the requirement of operation while 4 cases below the level and needed to increase the local anesthetic through epidural. Group B, 68 cases＇ anaesthetic levels achieved the requirement of operation, 10 cases below the required level and 4 cases of them needed to increase the local anesthetic through epidural. 9 cases altered general anaesthesia in need to complete the operation. Conclusion： The combined spinal-epidural anesthesia by two-points avoids the risk of scleromeninx perforation through the puncturation of epidural needle and controls the anaesthetic level ideally.

关 键 词：腰硬联合麻醉 两点穿刺 盆腔手术 

分 类 号：R614.4[医药卫生—麻醉学]