旁入穿刺法细针腰麻在剖宫产手术中的应用  

Spinal anesthesia using paramedian approach with fine spinal needle for patients undergoing cesarean section

作　　者：高云春 GAO Yunchun(People＇s Hospital of Xinzhou,Xinzhou 034000,Shanx)

机构地区：[1]忻州市人民医院,山西忻州034000

出　　处：《临床医药实践》2018年第11期826-828,共3页Proceeding of Clinical Medicine

摘　　要：目的:观察旁入穿刺法细针腰麻用于剖宫产手术的临床效果。方法:选择ASAⅠ～Ⅱ级接受剖宫产手术患者100例,随机分为笔尖式细针腰麻组(D组)和普通斜面针腰麻组(C组),每组50例。两组患者均取左侧卧位,经L3～4棘突间隙中点旁开约1. 5 cm、与皮肤成约75°角,对准棘突间孔方向行蛛网膜下腔穿刺,成功后注入0. 5%重比重布比卡因局麻药1. 8～2. 2 m L。记录麻醉穿刺时间、感觉阻滞平面达T6所需时间、改良Bromage评分达3级所需时间,记录术中、术后麻醉相关并发症发生情况。结果:C组穿刺时间更短,与D组比较差异有统计学意义(P <0. 05)。两组感觉阻滞平面达T6所需时间、改良Bromage评分达3级所需时间比较差异均无统计学意义(P> 0. 05)。两组术中低血压、恶心呕吐发生率比较差异无统计学意义(P> 0. 05)。D组术后头痛、腰痛发生率低于C组,差异有统计学意义(P <0. 05)。结论:在剖宫产手术中,与普通斜面针腰麻相比,旁入穿刺法细针腰麻术后头痛、背痛等麻醉相关并发症发生率更低,感觉、运动阻滞效果相似,但麻醉穿刺时间延长。Objective ：To observe the clinic effect of spinal anesthesia using paramedian approach with fine spinal needle for patients undergoing cesarean section. Methods ：All 100 ASA Ⅰ - Ⅱ patients undergoing cesarean section were randomly divided into two groups：pencil -point 25G spinal needles group（ D, n = 50） , cutting -beveled 22G spinal needles group（ C, n = 50）. Spinal anesthesia was performed using paramedian approach in left lateral position in group D and group C. Puncture time of spinal anesthesia, the fixed time of sensory- block and the degree of motor block were recorded, incidence of complication of anesthesia were calculated. Results ： There was significant change in parameters of puncture time of spinal anesthesia and incidence of postoperative headache and lumbago between group C and group D（P 〈 0.05 ）. There was no significant change in the degrees of sensory and motor block （ P 〉 0.05 ）. Conclusion ： In cesarean sections, compared to spinal anesthesia with cutting - beveled 22G spinal needles, spinal anesthesia using paramedian approach with pencil -point 25G spinal needles can reduce incidence of postoperative headache and lumbago.

关 键 词：蛛网膜下腔阻滞 腰椎穿刺针 剖宫产术 

分 类 号：R614[医药卫生—麻醉学]