坐位下行上胸段硬膜外穿刺31例临床分析  

Upper thoracic epidural puncture in sitting position with 31 cases analyzes

作　　者：张治明[1] 张安生[1] 欧阳帆[1] 曾宾[1] 王剑鸣[1] 

机构地区：[1]郴州市第一人民医院麻醉科,湖南郴州423000

出　　处：《海南医学》2010年第23期15-17,共3页Hainan Medical Journal

基　　金：郴州市科技局资助项目(编号:2008GL12)

摘　　要：目的探讨坐位下行上胸段硬膜外穿刺的效果。方法择期行乳腺区段切除或胸前壁手术的患者31例,在助手的帮助下,按拟定好的要求摆好体位,并按程序进行硬膜外穿刺并留置硬膜外导管。记录局麻开始到置管成功所需要的时间和穿刺次数,手术结束后,拔除硬膜外导管并更换穿刺点敷料;在术后的第三天回访,以痛觉模拟评分(VSA)询问患者穿刺点局部疼痛情况并测量穿刺点敷料渗出面积。结果 31例患者中有30(96.8%)例患者在30min内穿刺成功,1例患者因为穿刺时间过长(>30min),改成全身麻醉,平均穿刺时间为(12.3±7.2)min,最短穿刺时间为3min,最长穿刺时间为28min;平均穿刺次数为(2.1±1.8)次,最多穿刺次数为6次,有8例患者一次穿刺成功;6例患者述在平卧位穿刺点有中度疼痛,其余患者均为轻度疼痛;穿刺次数与穿刺后VSA的疼痛评分正相关(r=0.525);所有患者穿刺点均无明显出血,敷料渗出面积为(2.2±1.1)cm2,且呈正态分布。结论坐位下行上胸段硬膜外穿刺30min成功率高,无明显穿刺后疼痛和出血。Objective To review the effect of upper thoracic epidural puncture in sitting position.Methods 31 patients for elective segment breast or lump chest wall excise received epidural puncture in sitting position with help of the assistant＇s instruction,all the patients were placed with a epidural catheter after a successful puncture.The time from local anesthesia of skin to the catheter was placed （Time For Epidural Puncture;TEP） and the numbers of try （NT） were recorded;the catheter were removed at the finish of the operation,and a new wound dressings were placed at the point of puncture.All the patients＇ pain of puncture point was assessed with Visual Analogue Score （VSA） and the blood stain of the wound dressings were measured at the third day.Results 30 （96.8%） were succeed in puncture and catheter-placement in 30 min,one received general anesthesia because of epidural for longer TEP （30 min）.In 30 cases,TEP is 12.3±7.2 min,the minimum is 3 min,the maximum is 28 min;the Nt is 2.1±1.8,the most is 6,and 9 cases were succeed in one time;6 patients had a moderately pain when laying in the bed,while the left had a slight pain or no pain;There have positive correlation between TEP and NT（r=0.525）;no one had obviously bleed of puncture point,the area of blood stain was 2.2±1.1 square cm,the maximum is 4.6 square cm.Conclusion Upper thoracic epidural puncture in sitting position have a highly success and no obviously adverse effect.

关 键 词：麻醉体位 坐位 硬膜外穿刺 脊椎 上胸段 

分 类 号：R614.1[医药卫生—麻醉学]