正常足月妊娠妇女与非孕妇女腰段硬膜外腔压力的对比研究  

Comparative study of lumbar epidural pressure in full term pregnant women and non-pregnant women

作　　者：桂靖[1] 庞磊[2] 孙悦[3] 王艳芬[4] 麻海春[2] 南玲 

机构地区：[1]南华大学第二附属医院麻醉科,湖南衡阳421001 [2]吉林大学第一医院麻醉科 [3]吉林大学第一医院手术室 [4]吉林大学第二医院消化科

出　　处：《中国妇幼保健》2014年第2期180-183,共4页Maternal and Child Health Care of China

基　　金：吴阶平医学基金会项目(320.6750.1336)

摘　　要：目的:探讨正常足月妊娠妇女与非孕妇女侧卧位及仰卧位腰段硬膜外腔压力以及注射局麻药后硬膜外腔压力的变化。方法:选取ASA分级Ⅰ～Ⅱ级正常足月妊娠妇女(P组)20例和非孕妇女(NP组)15例,于L2-3间隙行脊麻-硬膜外联合麻醉。分别测定侧卧位时穿刺针进入硬膜外腔瞬间(T0)、穿刺针进入硬膜外腔30 s(T1)、60 s(T2)、90 s(T3),仰卧位后30 s(T4)、60 s(T5)、90 s(T6)以及硬膜外腔给予2%利多卡因5 ml后30 s(T7)、60 s(T8)、90 s(T9)10个时间点硬膜外腔压力。结果:T0～T9各时间点硬膜外腔压力均为正值。正常足月妊娠妇女T3、T6时间点硬膜外腔压力为(14.1±2.1)mmHg、(21.3±4.0)mmHg;非孕妇女T3、T6时间点硬膜外腔压力为(11.1±4.6)mmHg、(17.0±5.3)mmHg。T2、T3、T5、T6、T8、T9时间点硬膜外腔压力P组大于NP组,差异有统计学意义。各组T6与T7时间点硬膜外腔压力比较差异有统计学意义。T6与T8、T9时间点硬膜外压力比较差异无统计学意义。结论:正常足月妊娠妇女与非孕妇女侧卧位及仰卧位时腰段硬膜外腔压力为正值,并非传统观点所认为的负压。侧卧位及仰卧位时足月妊娠妇女硬膜外腔压力高于非孕妇女。仰卧位时,以0.5 ml/s的速度通过硬膜外导管推注2%利多卡因5 ml,硬膜外压力增高不超过90 s。Objective： To study the lumbar epidural pressure in lull term pregnant women and non - pregnant women in the lateral position and the supine position respectively, and the change of the epidural pressure after injection of local anesthetics. Methods： Twenty American Society of Anesthesiologists （ASA） physical status I orII full term pregnant women （Group P） and fifteen non -pregnant women （Group NP） were given combined spinal -epidural anesthesia （CSEA） at L2 -3 intervertebral space. The instantaneous pressure were measured when Tuohy needle was advanced into the epidural space （ ＇ID ） , the pressure 30 seconds （ T1 ） , 60 seconds （ T2 ）, 90 seconds （ T3 ） after that, and the pressure 30 seconds （ T4）, 60 seconds （ T5 ）, 90 seconds （T6） after the patients were in the supine position, and the pressure 30 seconds （ T7 ） , 60 seconds （ T8 ） and 90 seconds （ T9 ） ailer 5 ml of 2% lidoeaine was injected into the epidural space re- spectively. Results： All epidural pressm＇es were positive from TO to T9. The pressures at T3 and T6 in full term pregnant women were （ 14. 1 ±2. 1 ） mmHg, （21.3 ±4. 0） mmHg; and in non - pregnant women were （ 11.1 ±4. 6） mmHg, （ 17. 0±5.3） mmHg. There were significant differences in epidural pressure at T2, T3, T5, T6, T8, T9 between the two groups, the epidural pressure in Group P was greater than Group NP. There were significant differences in epidural pressure at T6 and T7 in each group, and no significant differences at T6, T8 and 39. Conclusion： Tile epidural pressures are positive in both full term pregnant women and non -pregnant women in the lateral and the supine position, not negative as traditional view. The epidural pressures in pregnant women are greater than that in the non - preg- nant women both in the lateral and the supine position. The increase of the epidural pressure in the supine position lasted no more than 90 seconds after injection of 5 nil of 2% lidocaine at the rate of 0. 5 ml/s

关 键 词：硬膜外腔 压力妊娠 

分 类 号：R714[医药卫生—妇产科学]