蛛网膜下腔局麻药注药模式对麻醉效果的影响  

Influence of injection mode of local anesthetics in subarachnoid space on narcotic effect

作　　者：刘新[1] 王群[1] 张维亮[1] 蒋强[1] 苏帆[1] 

机构地区：[1]山东中医药大学附属医院麻醉科,山东济南250014

出　　处：《中国医药导报》2015年第22期102-104,共3页China Medical Herald

基　　金：国家自然科学基金项目(81072960/H2902)

摘　　要：目的 观察蛛网膜下腔罗哌卡因注入时针缺口朝向不同对麻醉效果的影响。方法 选择2014年1-7月山东中医药大学附属医院拟行下肢手术的患者40例,采用随机数字方法将其分成Ⅰ、Ⅱ组,每组各20例。Ⅰ组腰麻针缺口垂直朝向天花板,Ⅱ组腰麻针缺口水平朝向患者尾侧,两组均于蛛网膜下腔注射0.75%罗哌卡因2 m L。观察动脉压、心率、脉搏氧饱和度、镇痛起效时间、运动阻滞起效时间、给药后20 min最高痛觉阻滞平面、麻醉持续时间。并观察注药阻滞后出现的头痛、恶心、尿潴留及马尾综合征等不良反应。结果 两组镇痛起效时间比较,差异无统计学意义（P〉0.05）;运动阻滞起效时间,Ⅰ组长于Ⅱ组（P〈0.05）;最高阻滞平面,Ⅰ组为T9,Ⅱ组为T11;麻醉持续时间,Ⅰ组较Ⅱ组短（P〈0.05）;Ⅰ组术中发生恶心1例。结论腰麻针缺口的朝向不同对麻醉效果产生一定的影响;腰麻针缺口垂直朝向能获得较广范围的阻滞,但阻滞时间相应缩短;针缺口水平朝向尾侧阻滞范围相应较窄,但阻滞时间相应延长。Objective To observe the effect of anesthesia in the different lumbar hemp needle gap toward of injection of Ropivacaine for spinal anesthesia. Methods 40 patients with ASA lower extremity surgery from January to July 2014 in Affiliated Hospital of Shandong Traditional Chinese Medical University were selected, and they were randomly divided into group Ⅰ and group Ⅱ according random number table, with 20 cases in each group. In group Ⅰ with spinal anesthesia needle gap toward kept up, group Ⅱ with spinal needle gap toward kept down, and in both two groups,0.75% Ropivacaine 2 m L were injected into the subarachnoid space. The arterial blood pressure, heart rate, pulse oxygen saturation, the onset time of analgesia, motor block onset time, the maximum pain block plane, duration of anesthesia, the emergence of other drug use or headache, nausea, urinary retention, cauda equina syndrome and other adverse reactions of two groups were observed. Results No difference was found in onset time of analgesia between two groups（P〉0.05））; in motor block onset time, group Ⅰ was longer than that of the group Ⅱ（P〈0.05）; in the highest block level, group Ⅰ was T9, groupⅡ was T11; in anesthesia duration, group Ⅰ was more short than that of the group Ⅱ（P〈0.05）; 1 case nausea occurred in group Ⅰ. Conclusion Lumbar hemp needle gap toward different direction produces different influence on effect of anesthesia; vertical direction of lumbar hemp needle gap to win a wide range of block but the blocking time shortened accordingly; needle hole toward the caudal blocks a narrow range corresponding, but the blocking time extended accordingly.

关 键 词：腰麻 注药方向 罗哌卡因 

分 类 号：R614.3[医药卫生—麻醉学]