硬膜外麻醉穿刺置管导管误入血管的先兆指征和规避方法  

The foreboding indications of wrong inserting of catheterization into a blood vessel in epidural anesthesia and ways to avoid it

作　　者：滑炜 高怀新 

机构地区：[1]中航工业145医院麻醉科,陕西兴平713106 [2]中核工业215医院麻醉科,陕西咸阳712100

出　　处：《华夏医学》2011年第2期160-162,共3页Acta Medicinae Sinica

摘　　要：目的:通过大样本观察硬膜外麻醉穿刺置管导管误入血管的先兆指征和规避方法。方法:1 698例需行硬膜外麻醉的患者,在施行硬膜外穿刺置管时根据置管过程中是否遇到阻力分组。置管过程顺畅未遇明显阻力者归入A组;置管过程不顺畅遇到明显阻力者,暂停置管,依据该患者住院号末位数的奇偶性分别归组(设定0为偶数),奇数者归入B组,偶数者归入C组。B组采用加压平推法置管,C组采用旋入法置管。置管完成后,观察各组患者的例数及导管误入血管的阳性率。结果:A组患者1 574例,B组患者54例,C组患者70例。B组导管误入血管的阳性率非常明显地高于A、C两组(P<0.01),A、C两组之间则无显著差异。结论:置管过程不顺畅遇到阻力可作为导管误入血管的先兆指征,在置管过程中遇到阻力后采用旋入法置管可有效避免导管误入血管。Objective： Through large sample,to observe the foreboding indications of wrong inserting of catheterization into a blood vessel in epidural anesthesia and ways to avoid it.Methods： 1 698 cases of epidural anesthesia patients were divided into 3 groups in terms of whether it would meet resistence in the implementation of epidural catheterization,Group A（with no resistence in the implementation of epidural catheterization）;if there was obvious resistence in catheterization for patients,the catheter insertion were quitted for the time being,and the patients were then divided into Group B（according to their odd hospitalization number） and Group C in accordance with their even hospitalization numbers including 0）.Extrapolation method of pressurized tube was used in Group B and twist tube was applied in Group C.Upon completion of the tubes,the number of cases and the positive rate of patients with wrong catheterization into a blood vessel were observed.Results： Group A were with 1 574 cases,Group B with 54 cases and Group C with 70 cases.The positive rate of wrong catheterization into a blood vessel in Group B were significantly higher than that of Group A and Group C（P0.01）,and there was no obvious difference between Group A and Group C.Conclusion： Non-smooth and resistence in the course of inserting epidural catheterization can be used as an omen indications of wrong catheterization into the blood vessels.The used of twist tube while encounter resistance in the process of tube implememtation can be effective to avoid the wrong catheterization into the blood vessels.

关 键 词：误入血管 平推法 旋入法 

分 类 号：R614.42[医药卫生—麻醉学]