肢体幻像在产科腰硬联合麻醉后发生情况的临床观察  

Clinical observation of the occurrence of limb phantom after combined anesthesia of obstetrics

作　　者：李玲霞[1] 苏鸿莉[1] 胡彬[1] 代玲杰 LI Ling-xia;SU Hong-li;HU Bin;DAI Ling-jie(Department of Anesthesiology,Affiliated Hospital of Yan'an University,Yan'an 716000,China)

机构地区：[1]延安大学附属医院麻醉科

出　　处：《延安大学学报（医学科学版）》2019年第2期39-42,共4页Journal of Yan'an University:Medical Science Edition

基　　金：陕西省教育厅专项科研计划项目(16JK1866)

摘　　要：目的 对产科剖宫产病人实施腰硬联合麻醉后其肢体幻像现象进行临床观察,并对其发生情况进行探讨。方法 对94例腰硬联合麻醉下行剖宫产的患者自确定麻醉体位开始进行观察,对不同侧卧位、不同穿刺部位实施腰硬联合麻醉后肢体幻像的发生率、肢体幻像性质、产生肢体幻像的时间以及不良反应发生情况等进行了观察、记录和分析研究。结果 94例产科患者肢体幻像现象发生率高达76.60%;分别对94例穿刺部位为L3-4与L4-5剖宫产患者进行麻醉后肢体幻像发生情况进行观察,47例穿刺部位为L3-4患者肢体幻像现象发生率为74.47%;47例穿刺部位为L4-5患者中肢体幻像现象发生率为78.27%,P>0.05;不同侧卧位时,55例左侧卧位时肢体幻像现象发生率为72.73%,39例右侧卧位肢体幻像现象发生率为82.05%,P>0.05,差异无统计学意义;72例发生肢体幻像现象患者在不同侧卧位时,同侧下肢肢体幻像现象发生率极高,而对侧肢体幻象现象发生率较低,P<0.05,且不同侧卧位时对侧肢体幻像现象发生率极低;依据有无发生肢体幻像现象分组,比较不良两组患者不良反应发生率,P>0.05。结论 产科剖宫产患者硬腰联合麻醉后肢体幻像现象发生率较高,且不同侧卧位时,同侧肢体幻象现象发生率较高,可能与妊娠后期脑脊液和脊椎生理、解剖结构改变及局麻药作用、高糖代谢作用、重力效应等引起的快速、深度神经阻滞作用有关。Objective To observe the phenomenon of limb phantom after combined spinal and epidural anesthesia in obstetric cesarean section,and to explore its occurrence. Methods 94 patients with cesarean section underwent combined spinal and epidural anesthesia began to observe the anesthesia position.The incidence of limb phantoms,the nature of limb phantoms,the time of limb phantom and the occurrence of adverse reactions were observed,recorded and analyzed in different lateral and different puncture sites. Results The incidence of limb phantom in 94 obstetric patients was as high as 76.60%.The incidence of limb phantoms in 94 patients with cesarean section of L3-4 and L4-5 was observed.The incidence of limb phantom in 47 patients with L 3-4 was 74.47%.47 patients were puncture site.The incidence of limb phantom phenomenon in patients with L 4-5 was 78.27%, P >0.05.In different lateral recumbent position,the incidence of limb phantom in 55 cases of left lateral position was 72.73%,and the incidence of limb phantom phenomenon in 39 cases of right lateral position was 82.05%, P >0.05,the difference was not statistically significant.In 72 patients with limb phantom phenomenon,the incidence of limb phantom phenomenon in the ipsilateral lower extremity was extremely high,while the incidence of contralateral limb phantom phenomenon was lower, P <0.05,and contralateral limb phantom in different lateral recumbent positions.The incidence of phenomena is extremely low.According to the presence or absence of limb phantom phenomenon,the incidence of adverse reactions in the two groups was poor, P >0.05. Conclusion The incidence of limb phantom phenomenon is higher in patients with obstetric cesarean section after hard anesthesia combined with anesthesia.When the lateral position is different,the incidence of ipsilateral limb phantom phenomenon is higher.It may be related to the rapid and deep nerve block caused by cerebrospinal fluid and spinal physiology,anatomical structure changes,local anesthetic action,high glucose metabolism,and

关 键 词：肢体幻像 腰硬联合 剖宫产 发生率 

分 类 号：R614[医药卫生—麻醉学]