地塞米松对椎管内麻醉神经并发症早期干预的研究  

Study on the early intervention of dexamethasone for the neurological complications caused by the intravertebral anesthesia

作　　者：王玉玲[1] 邱郁群[1] 阮志琴[1] 陈艳[1] 黄梅[1] 

机构地区：[1]广东省茂名市妇幼保健院麻醉科,525000

出　　处：《中国医药》2014年第7期1003-1005,共3页China Medicine

基　　金：广东省茂名市医学类科技计划（2013131）

摘　　要：目的探讨地塞米松对椎管内麻醉过程中出现神经并发症的预防效果。方法2005年1月至2009年10月在椎管内麻醉穿刺、置管等操作过程中出现异感1 870例为对照组，以2009年11月至2013年5月出现异感的1 548例患者为治疗组。对照组患者以2 ml/h速度给予 0.125%左布比卡因100 ml与舒芬太尼100 μg的硬膜外腔术后镇痛；治疗组患者经硬膜外腔注入地塞米松10 mg，然后行经静脉术后镇痛治疗，镇痛液为舒芬太尼100 μg与布托非诺5 mg，0.9%氯化钠注射液稀释至100 ml。观察2组患者触发异感情况、神经并发症类型及治疗效果，并进行统计学分析。结果2组患者触发异感时针尖同位置比较，差异无统计学意义（P〉0.05）。治疗组异感程度a、b、c级分别为1 249例（80.7%）、245例（15.8%）、54例（3.5%）；对照组分别为1 227例（65.6%）、481例（25.7%）、162例（8.7%），2组患者同级异感程度比较，差异具有统计学意义（P〈0.05）。治疗组发生暂时性神经根激惹（TNS）968例（62.5%）、马尾综合征194例（12.5%）、神经刺激征97例（6.3%）、延迟性骶神经感觉障碍0例（0.0%）、其他神经并发症289例（18.7%）;对照组分别为650例（34.8%）、386例（20.6%）、163例（8.7%）、3例（0.2%）、528例（28.2%）。对照组TNS比例明显低于治疗组，组间比较差异有统计学意义（P〈0.05）；而马尾综合征、延迟性骶神经感觉障碍发生率高于对照组，组间比较差异有统计学意义（P〈0.05）。结论通过地塞米松对椎管内穿刺神经并发症进行早期干预，能明显减少穿刺引起的神经并发症发生率，患者症状轻，易于恢复。ObjectiveTo observe the prevention effects of dexamethasone on the neurological complications occurred during the intravertebral anesthesia. MethodsOne thousand eight hundred and seventy patients who had abnormal sensation when they were conducted puncture and catheterization after intravertebral anesthesia from January 2005 to October 2009, were regarded as the control group, while the other 1 548 cases patients who had abnormal sensation from November 2009 to May 2013 were regarded as the treatment group. In the form of epidural anesthesia, the 0.125% levobupivacaine of 100 ml and sufentanil of 100 μg were conducted at the speed of 2 ml/h for the patients in the control group. The dexamethasone of 10 mg was injected through epidural cavity for the patients in the treatment group, then conducting the intravenous analgesia after operation. The analgestic liquid is the sufentanil of 100 μg and butorphanol of 5 mg diluting to 100 ml with the physiological saline. The occurring of abnormal sensation, types of neurological complications and treatment effects of the patients in two groups were observed, then making the statistical analysis. ResultsThe locations of tips for stimulating the abnormal sensations in two groups were the same, the differences had no statistical significance （P〉0.05）. The degrees of abnormal sensation for grade a, b and c in the treatment group were respectively 1 249 cases （80.7%）, 275 cases （15.8%）, 54 cases （3.5%）, while those in the control group were respectively 1 227 cases （65.6%）, 481 cases （25.7%） and 162 cases （8.7%）. After comparing the abnormal sensation with the same grade of the patients in two groups, the differences had statistical significance （P〈0.05）. The types of neurological complications in the treatment group were as follows： TNS of 968 cases （62.5%）,CES of 194 cases （12.5%）, nerve stimulation of 97 cases （6.3%）, delayed sacral nerve sensory obstacle of o case （0.0%）, other neurological complications of 289 case

关 键 词：椎管内麻醉 神经并发症 地塞米松 

分 类 号：R614[医药卫生—麻醉学]