硬膜外置管前预充生理盐水或利多卡因对腰硬联合麻醉下剖宫产术产妇麻醉效果及置管误入血管的影响  

Effects of pre-filling with saline or lidocaine before epidural catheter placement on anesthesia efficacy of caesarean section under combined spinal-epidural anesthesia and vein cannulation during epidural catheter placement

作　　者：俞瑾 刘朝文[1] 向波[1] 陈虎[1] YU Jin;LIU Chaowen;XIANG Bo;CHEN Hu(Department of Anesthesiology,Chongqing Health Center for Women and Children,Chongqing 401147,China)

机构地区：[1]重庆市妇幼保健院麻醉科,重庆401147

出　　处：《检验医学与临床》2020年第19期2784-2787,共4页Laboratory Medicine and Clinic

基　　金：重庆市妇幼保健院2019年院级科研项目(2019YJMS02)。

摘　　要：目的比较腰硬联合麻醉中硬膜外置管前预充生理盐水或利多卡因对产妇麻醉效果及血管损伤、置管误入血管的影响。方法纳入腰硬联合麻醉下行剖宫产术的产妇150例,随机分为C组、NS3组、NS5组、LK3组及LK5组,每组30例。观察记录置入硬膜外导管时穿刺针尾见淡红色血水、回抽见淡红色血水、置入血管及置入时有阻力的发生情况。平卧后即刻测定感觉阻滞平面与运动阻滞平面情况。结果5组产妇一般资料及各时点MAP与心率组间比较,差异无统计学意义(P>0.05)。5组产妇平卧后即刻与3 min后测量麻醉平面上界及运动阻滞发生情况比较,差异无统计学意义(P>0.05)。与C组比较,其余各组硬膜外置管时有阻力、穿刺针尾见淡红色血水、回抽见淡红色血水的发生率均降低,差异有统计学意义(P<0.05)。硬膜外导管置入血管的发生率组间比较,差异无统计学意义(P>0.05)。结论硬膜外置管前预充生理盐水或利多卡因未能降低硬膜外导管误入血管的发生率,但可以降低硬膜外置管诱发的血管损伤发生率,且对麻醉效果无明显影响。Objective To compare the effects of pre-filling with saline or lidocaine before epidural catheterization on anesthesia efficacy,venous plexus injury and vein cannulation for caesarean section under combined spinal-epidural anesthesia.Methods A total of 150 parturients undergoing cesarean section under combined spinal epidural anesthesia were randomly divided into group C,group NS3,group NS5,group LK3 and group LK5,with 30 cases in each group.The occurrence of light red blood water at the end of puncture needle,light red blood water in blood vessel and insertion resistance when inserting epidural catheter were observed and recorded.The sensory block level and motor block were measured immediately after supine.Results There was no significant difference in general information,MAP and heart rate between the five groups(P>0.05).There was no significant difference in the upper limit of anesthesia level and the incidence of motor block between the five groups immediately after lying down and 3 min later(P>0.05).Compared with group C,the incidence of resistance during epidural catheterization,light red blood water at the end of puncture needle and light red blood water after epidural catheter withdrawal in other groups were significantly lower than those in group C(P<0.05).There was no significant difference in the incidence of epidural catheter placement between groups(P>0.05).Conclusion Pre-filling normal saline or lidocaine before epidural catheterization can not reduce the incidence of epidural catheter entering into blood vessels by mistake,but can reduce the incidence of vascular injury induced by epidural catheterization,and has no obvious effect on anesthesia effect.

关 键 词：硬膜外 预充 生理盐水 利多卡因 腰硬联合麻醉 

分 类 号：R614.4[医药卫生—麻醉学]