L_(4～5)椎间隙“把持式”锐角侧入路硬脊膜外腔穿刺术临床分析  

Clinical analysis of "Bcs" acute angle epidural cavity puncture by lateral lumbar segment approach through intervertebral space L_(4-5)

作　　者：胡彬[1] 段雨杉[1] 王晓艳[1] 吴仲烨[1] 任斐[1] 李玲霞[1] 张兆伟[1] 

机构地区：[1]延安大学附属医院麻醉科,陕西延安716000

出　　处：《中国现代医生》2016年第2期106-108,118,共4页China Modern Doctor

摘　　要：目的分析硬-腰联合麻醉L4-5椎间隙＂把持式＂锐角侧入路硬脊膜外腔穿刺术的临床应用价值。方法回顾性分析2013年2～12月ASA分级Ⅰ～Ⅲ级硬-腰联合麻醉病例。患者采用侧卧位,Tuffier’s线确定脊柱间隙,L4-5椎间隙之间硬-腰联合麻醉套针穿刺（针内针型）。正中入路、锐角侧入路,＂把持式＂方法穿刺。硬外穿刺、腰穿任何一方累计三次失败者,改用其他方法。硬外穿刺一次成功病例数,硬外、腰麻穿刺针触及到神经病例数,硬外穿刺耗时,穿刺后第6天腰痛病例数,置管顺畅否,引流脑脊液情况。结果统计到符合条件的病例261例所用穿刺方法：正中入路穿刺法（Z组）133例、＂把持式＂锐角侧入路穿刺法（B组）128例。Z组较B组单次穿刺用时短（P〈0.05）;麻醉后第6天腰痛发生率高（P〈0.05）;腰穿一次成功率低（P〈0.01）;腰穿碰到神经、置管有阻力、脑脊液引流不畅发生率高（P〈0.01）。结论 L4-5间隙硬外穿刺,＂把持式＂锐角侧入路优于正中入路,值得推广。Objective To analyze the value of ＂Bcs＂ acute angle epidural cavity puncture by lateral lumbar segment approach through intervertebral space L4-5. Methods Reviewed the cases with spinal-epidural anesthesia from February to December in 2013, ASAⅠ-Ⅲ. Laying the patients on lateral recumbent position, determined the position by Tuffier＇s line, used the intra-needle in CSEA through intervertebral space L4-5by lateral or central lumbar segment approach with ＂Bcs＂.3 times failure turned to the other method. Observation indexes： the number of cases succeed on first puncture, the number of cases puncture needle encountered nerves, the time of puncture, the number of lumbodynia on6 days after operation, whether hard to place tube, drainage of cerebrospinal fluid. Results 261 cases were counted,133 cases used epidural cavity puncture by centre lumbar segment approach（group Z）, 128 cases used ＂Bcs＂ acute angle epidural cavity puncture by lateral lumbar segment approach（group B）. Group Z used short time than group B in single epidural puncture（P〈0.05）; The rate of lumbodynia on 6 days after operation was higher（P〈0.05）; The rate of succeed on first puncture lower（P〈0.01）; higher rate on puncture needle encountered nerves, hard to place tube and drainage of cerebrospinal fluid（P〈0.01）. Conclusion ＂Bcs＂ acute angle epidural cavity puncture by lateral lumbar segment approach through intervertebral space L4-5better than by central, worthy of promotion.

关 键 词：腰4~5椎间隙 “把持式” 锐角侧入路 硬膜外腔穿刺术 

分 类 号：R614.4[医药卫生—麻醉学]