超声引导L5-S1和L4-5间隙腰麻用于经尿道输尿管镜碎石术麻醉比较  

Comparison of anesthetic effect of ultrasound-guided spinal anesthesia at L5-S1 and L4-5 intervertebral space in transurethral ureteroscopic lithotripsy

作　　者：王月 刘勇[1] 周志强 陈堃 吴茜 梅伟[1] WANG Yue;LIU Yong;ZHOU Zhiqiang(Department of Anesthesiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,武汉430030 [2]泰康同济(武汉)医院麻醉科 [3]华中科技大学同济医学院附属协和医院麻醉科

出　　处：《临床外科杂志》2020年第12期1174-1177,共4页Journal of Clinical Surgery

摘　　要：目的比较超声实时引导L5-S1或L4-5椎间隙腰麻用于经尿道输尿管镜碎石术中的麻醉效果。方法 2018年7月~12月择期行经尿道输尿管镜碎石术病人40例,根据超声预扫描椎间隙的穿刺条件分为两组,经L5-S1间隙穿刺组为A组(20例),经L4-5间隙穿刺组为B组(20例)。40例病人均采用实时超声引导下腰麻,穿刺成功后主管医师结合临床工作经验注入0.5%布比卡因(重比重)10~17 mg。记录病人围术期各不同时间节点血流动力学数据、手术时间,腰麻时所用布比卡因总量、阻滞总节段数,手术麻醉效果、麻醉满意率,麻醉并发症发生的情况,以及术中镇静镇痛药物和血管活性药物的使用情况。结果两组病人术中生命体征平稳,不同时点心率、收缩压和舒张压比较差异无统计学意义(P>0.05)。A组和B组麻醉满意率均为100%,术中无一例病人因疼痛或阻滞范围不足中转全麻。B组有1例病人需使用血管活性药维持血流动力学平稳。所有病人均无并发症的发生。A组和B组的布比卡因用量比较差异无统计学意义(P>0.05),但相同布比卡因用量下A组阻滞平面总节段数低于B组,差异有统计学意义[A组(14±2),B组(15±2),P<0.05]。结论超声引导下L5-S1和L4-5的腰麻均可安全用于经尿道输尿管镜碎石术,但在相同剂量布比卡因用量情况下,A组阻滞平面节段数更低。Objective To evaluate the anesthesia effect of ultrasound-guided single shot spinal anesthesia at L5-S1 and L4-5 intervertebral space in transurethral ureteroscopic lithotripsy.Methods Forty patients who were scheduled for transurethral ureteroscopic lithotripsy were enrolled in this study.The patients allocated randomly into two parallel groups(20 patients for each),namely L5-S1(Group A) and L4-5(Group B).Forty patients underwent real-time ultrasound-guided spinal anesthesia,When the puncture is successful,10 to 17 mg of 0.5% bupivacaine was injected.The hemodynamic parameters,total duration of surgery,anesthesia effect,anesthesia satisfaction,total bupivacaine used,total blocked segments,sedative analgesics and vasoactive drugs used were recorded.Results The vital signs were stable during the operation.There was no significant difference in heart rate(P>0.05),systolic blood pressure and diastolic blood pressure between the two groups at each time measured.The satisfaction rate of anesthesia in both group A and group B was 100%.None of the patients transferred to general anesthesia due to pain or insufficient block.One patient in group B needed vasoactive drugs to maintain hemodynamic stability.There was no statistical significance in the dose of bupivacaine used in group A and group B(P>0.05),but the total blocked segments in group A was less than that in group B with the equal bupivacaine dosage[Group A was(14±2),Group B was(15±2),P<0.05].Conclusion Real-time ultrasound-guided spinal anesthesia at L5-S1 and L4-5 intervertebral space are feasible and can be safely used for patients underwent transurethral ureteroscopic lithotripsy.With the same dose of bupivacaine,spinal anesthesia by L5-S1 approach produced less blocked segments than L4-5 approach.

关 键 词：腰麻 超声引导 经尿道输尿管镜碎石术 布比卡因 

分 类 号：R614[医药卫生—麻醉学]