硬膜外腔注射生理盐水预防剖宫产腰穿后头痛的效果观察  

Effect observation of epidural injection of normal saline preventing postlumbar puncture headache for caesarean section

作　　者：王鹤 王文法 

机构地区：[1]云南省楚雄彝族自治州人民医院新区医院麻醉科,云南楚雄675000

出　　处：《中国当代医药》2016年第6期49-52,共4页China Modern Medicine

摘　　要：目的观察硬膜外腔注射生理盐水预防腰硬联合麻醉下行剖宫产腰穿后头痛的效果。方法选取2013年5月～2014年5月在我院接受剖宫产的184例患者。采用随机数字表法,将患者分为对照组(C组)和研究组(R组),每组92例。两组均于腰硬联合麻醉下行剖宫产手术。C组在腰硬联合麻醉腰麻成功后直接放置硬膜外导管;R组在腰硬联合麻醉腰麻成功后立刻向硬膜外腔注射5 ml生理盐水才放置硬膜外导管。麻醉成功后,保持血流动力学稳定。术后均采用患者自控静脉镇痛。安返病房后均去枕平卧6 h,并随访患者5 d。记录两组术后发生头痛的例数;麻醉成功后,记录两组麻醉的最高阻滞平面、低血压发生率及需要应用麻黄碱提升血压的患者例数。结果与C组比较,R组的最高阻滞平面相对更高,差异有统计学意义(P<0.05)。两组低血压发生率及需应用麻黄碱患者的比例差异无统计学意义(P>0.05)。C组有7例患者在术后48 h内发生头痛,发生率为7.6%,R组则无一例患者发生头痛,两组头痛发生率差异有统计学意义(P<0.05)。C组7例头痛患者中,6例经治疗后好转出院,1例出院后1个月余好转。结论剖宫产患者在腰硬联合麻醉腰麻成功后立刻向硬膜外腔注射生理盐水能较好地预防腰穿后头痛。Objective To observe the effect of epidural injection of normal saline via epidural space preventing postlumbar puncture headache for caesarean section under combined spinal-epidural anesthesia. Methods From May 2013 to May 2014,184 patients undergone caesarean section in our hospital were selected.By a random number table,they were evenly divided into control group(group C) and research group(group R),and there were 92 cases in each group.Caesarean section was implemented under combined spinal-epidural anesthesia in both groups.In group C,epidural catheter was directly implanted after the success of combined spinal-epidural anesthesia.In group R,5 ml normal saline was injected via epidural space right away after the success of combined spinal-epidural anesthesia,then epidural catheter was implanted.After the success of anesthesia,haemodynamics was maintained stable.Patient controlled intravenous analgesia was used after surgery.After patients were returned to the ward safely,and they were lying in horizontal position without pillow for 6 h,and patients were followed up for 5 days.The number of headache after surgery in two groups was recorded,and after successful anesthesia,the highest block plane of anesthesia,occurrence rate of hypotension and cases of increasing blood pressure using ephedrine in two groups was recorded respectively. Results Compared with group C,the highest block plane of group R was relatively higher,and the difference was statistically significant(P<0.05).There was no statistical difference of occurrence rate of hypotension and proportion of patients using ephedrine between two groups(P >0.05).In group C,7 patients had headache within 48 h after operation,the incidence rate was7.6%,and there was no headache in group R,and there was a statistical difference of occurrence rate of headache between the two groups(P<0.05).Among 7 patients with headache C group,6 patients were cured to become better to leave hospital,1 case become better after more than 1 months leaving hospital. Conclusion For p

关 键 词：腰穿后头痛 剖宫产 腰硬联合麻醉 硬膜外腔 生理盐水 

分 类 号：R719.8[医药卫生—妇产科学]