压力图像与回流性状双指征法辅助硬膜外腔定位麻醉的准确性与可行性研究  

Accuracy and feasibility of dynamic pressure graph and liquid reflow as double indication for epidural space orientation during epidural puncture

作　　者：龚玉华[1] 石海霞[1] 武丽芳[1] 拉布旦白拉[1] 陈冬梅[1] 钟海燕[1] 李利彪[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》2011年第6期691-694,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨压力图像与回流液相双指征法辅助硬膜外麻醉定位与监测的准确性与可行性。方法择期硬膜外麻醉患者1200例，ASAⅠ～Ⅲ级，年龄、体重、性别不限。根据硬膜外穿刺节段分为6组（每组200例）：颈组（C4-5／C6-7，C组），胸Ⅰ组（T3-4/T4-5，T1组），胸Ⅱ组（T8-9／T9-10，T2组），胸Ⅲ组（T10-11／T11-12，T3组），腰Ⅰ组（T12～L1／L1-2，L1组），腰Ⅱ组（L2-3/L3-4，L2组）。所有患者均采用直人法进针，固定至脊上韧带后，退出针芯，穿刺针经三通与ICP传感器连接，进针的同时观察不同层次压力数值与图像变化，当图像显示直线返折，继而曲线波形出现且数值形成落差时，经三通注入3ml气泡盐水无压缩，即可确认进入硬膜外腔，头向置管15cm，退针后留管3cm，固定导管平卧，导管末端连接装有盐水的玻璃注射器。全程根据压力动态图像显示导管在硬膜外腔，观察回流液性状（-清；＋微红；＋＋显红；＋＋＋深红；＋＋＋＋血性）5min，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。记录到达黄韧带（T0）、硬膜外腔（T1）、注药动态平衡后（T2）的压力值。观察并记录分次注药后压力图像变化及阻滞效果，各类副作用。结果所有患者均未出现神经、脊髓损伤等并发症。、突破黄韧带前，压力数值呈急剧上升像，进针至黄韧带，压力波形为直线，压力数值为（82±26）mmHg（1mmHg=0．133kPa）。突破黄韧带进入硬膜外腔，压力图像呈特异性直线返折，继而出现正弦波形，压力数值明显降低到（7±12）mmHg。与T0比较，各组T1、T2均有降低（P〈0．05）。与T1比较，各组T1均升高（P〈0．05）。结论压力图像与回流液相双指征法辅助硬膜外麻醉准确可靠，简便易行，可常规用于各年龄组、各节段硬膜外麻醉。Objective To study the accuracy and feasibility of dynamic pressure graph and liquid reflow as double indication for epidural space orientation. Methods 1 200 ASA I -III patients undergone epidural anesthesia were enrolled. They were divided into 6 groups according to spinal segments of puncture site（n=200）： Cervical Group（C4-5/C5-6/C6-7, Group C）, Thoracic Group I （T3-4/T4-5, Group T1）, Thoracic Group II （T8-9/T9-10, Group T2）, Thoracic Group III （T10-11/T11-12, Group T3）, Lumbar Group I （T12-L1/L1-2, Group L1）, Lumbar Group II （L2-3/L3-4, Group L2）. Pressure graph were being recorded continuously. Midline epidural puncture were perfbrmed in all patients. The puncture needle was fixed to supraspinous ligament and connected to the ICP transducer by a 3-way stopcock. The pressure graph was observed during puncturing. After the appearance of steep decreasing pressure line followed by a curved wavefonn, 3 ml saline was injected through the 3-way stopcock. Successful puncture was confirmed by bubble compression test. The epidural tube was inserted 15 cm headward. After withdrawn the needle, 3 cm was left in the epidural space. The end of the tube was connected to a glass syringe filled with saline. The tube position in the epidural space was proved by dynamic pressure graph. The appearance of thee reflow liquid （-clear, ＋weak red, ＋＋obviously red, ＋＋＋deep red, ＋＋＋＋redness） was observed for 5 min. Patients whose liquid character between -＋＋＋ were given experimental and maintenance dose for surgery. The character of the reflow liquid was observed continuously during anesthesia. The time points were recorded when the needle reached the ligament flavum（T0） and the epidural space（T1）, and when a dynamic pressure balance（T2） was reached. The dynamic pressure graph, the effect of the blockage after each injection, and all complications were observed and recorded respectively. Results No complications were observed during tbe study. Pressure numerical v

关 键 词：硬膜外腔 图像 压力 液相 网流 监测 

分 类 号：R614[医药卫生—麻醉学]