超声引导下单次硬膜外麻醉在剖宫产手术中的应用  

Study of ultrasound guided single epidural space punctures in lumbar anesthesia

作　　者：孙希芝[1] 马加海[1] 李志[1] 

机构地区：[1]烟台毓璜顶医院麻醉科,山东烟台264000

出　　处：《泰山医学院学报》2012年第1期16-18,共3页Journal of Taishan Medical College

摘　　要：目的探讨超声引导技术在单次硬膜外穿刺中的应用价值。方法 80例患者随机分为连续硬膜外穿刺组(对照组)和超声引导下行单次硬膜外麻醉组(US组),每组各40例。阻力消失技术定位硬膜外穿刺组(对照组)采取传统的体表标志进针及阻力消失法确定硬膜外间隙位置,US组采用超声实时引导穿刺针进入硬膜外间隙。记录两组硬膜外准备时间、穿刺时间、麻醉起效时间、麻醉相关并发症和试穿次数。结果 2组患者均完成硬膜外穿刺操作,麻醉效果基本满足手术需要。两组患者的年龄和BMI等一般情况无明显差异。与对照组比较,超声引导硬膜外穿刺组麻醉前准备时间延长(P<0.01),但穿刺时间和麻醉起效时间明显缩短(P<0.01),并发症发生率明显低于对照组(P<0.01),试穿次数明显减少(P<0.05),差异有统计学意义。结论超声引导行单次硬膜外穿刺安全可靠,麻醉起效时间短,可减少并发症发生率,具有广泛的临床应用前景。Objective： To evaluate the role of real -time ultrasound guidance for epidural space punctures in lumbar anesthesia. Methods：Eighty patients who underwent lower abdomen surgery under epidural anesthesia were randomized into two groups. The ultrasonography group （ Group US, n = 40） performed the puncture procedure under real - time ultrasonography guidance. The control group （Group control,n =40） used classical methods which locates the epidural space by sur- face landmarks and loss - of - resistance （LOR） sensation. The time of pre - anesthetic preparation, time of operation, attempt times, complications and the effect of anesthesia were recorded. Results ： In all the 80 patients, the puncture was suc- cessfully performed and anesthesia effect was adequate for surgery. The time of pre - anesthetic preparation group US was longer than that of the control group （ P 〈 0.01 ）. While the time of operation and the time for anesthesia taking effect and complications were less in Group US（ P 〈 0.01 ）. The attempt times were less in Group US（ P 〈 0.05 ）. Conclusion： Ultra- sound can show the epidural space and adjacent structure clearly before puncture procedure. Single epidural space puncture by real - time ultrasound guide has higher success and reliability with less complication, and clinically it may have a good prospect.

关 键 词：硬膜外麻醉 超声引导 剖宫产 

分 类 号：R614[医药卫生—麻醉学]