预充回流试验法预防硬膜外局麻药毒性反应与提高阻滞成功率的临床研究  

Method of epidural space suffusion liquid reflow prevent epidural anesthesia toxic reflection and increase the effectivity of epidural anesthesia

作　　者：龚玉华[1] 石海霞[1] 吴洁[1] 韩志强[1] 陈冬梅[1] 胡雅娟[1] 武丽芳[1] 辛学东[1] 

机构地区：[1]内蒙古医学院附属医院麻醉科,呼和浩特010050

出　　处：《国际麻醉学与复苏杂志》2010年第6期495-498,共4页International Journal of Anesthesiology and Resuscitation

基　　金：内蒙古自治区科学基金资助项目（200711020955）

摘　　要：目的 观察探讨预充回流试验法用于预防硬膜外局麻药毒性反应与提高硬膜外阻滞成功率的可行性.方法 择期硬膜外麻醉手术患者2 000例,所有患者均左侧卧位,采用直入法穿刺进针,以气泡压缩法确认进入硬膜外腔后,硬膜外腔内留置导管5 cm,导管末端连接装有盐水的玻璃注射器.对照1 ml/2 s的推注力度,测试导管阻力,同时硬膜外腔内导管退至3 cm.回抽玻璃注射器无脑脊液或血液,即硬膜外腔预充注入生理盐水3 ml,观察1 min玻璃注射器内有无问流液.观察回流液性状（-清;＋微红;＋＋显红;＋＋＋深红;＋＋＋＋血性）5 min,回流液性状为（＋＋＋）以下,给予试验量、维持量完成手术.观察记录麻醉全程回流液性状,麻醉效果和并发症发生情况.结果 预充回流液与麻醉效果存在相关关系.1例患者手术开始42 min发现回流液为血液,停止硬膜外注药,有效避免了局麻药毒性反应.所有患者均未出现神经、脊髓损伤,有1例患者术毕回流液为血液.结论 预充回流试验法可作为硬膜外麻醉成功的可靠指征,有效避免局麻药毒性反应,及时监测、处理硬膜外血肿的发生.Objective To explore the feasibility of liquid reflow test in epidural space to prevent toxic reaction of local anesthetics and to improve success rate of epidural blocking. Methods 2 000 patients undergone epidural anesthesia were enrolled. All patients were on left recumbent position, punctured by normal beam testing And the epidural tube were left 3cm deep in epidural space. Draw 3ml saline with syringe, and connected it into the end of the tube. ResultS of liquid reflow test were classified as： yes or no.The character of reflow liquid were tobserved for 5 minutes （ -clear, ＋week red, ＋＋obviously red, ＋＋＋deep red, ＋＋＋＋redness）. The characters of liquid reflow, anesthesia effect and complications were continuously observed during the surgery.Results The reflow liquid has a relative effect with anesthesia performance. One patient＇s reflow liquid was found to be blood and were stopped injecting the drug into epidural space, so the possible toxic reaction were avoided. All patients had no nerve or spinal cord complications. One patient＇s reflow liquid was blood at the end of surgery. Conclusion Method of epidural space liquid reflow prevents anesthesia toxic reflection, increases the effectivity of epidural anesthesia and timely monitors the incidence of epidural hematoma.

关 键 词：硬膜外腔 液相 回流 毒性反应 局部麻醉药 监测 

分 类 号：R614[医药卫生—麻醉学]