不同硬膜外导管设计及脉冲速率对脉冲压力的影响  

The effect of epidural catheter design and delivery rate on the pressure generated during intermittent epidural bolus

作　　者：杜唯佳 易娟 宋英才 熊利泽 刘志强 Du Weijia;Yi Juan;Song Yingcai;Xiong Lize;Liu Zhiqiang(Department of Anesthesiology,Shanghai First Maternity and Infant Hospial,Tongji University School of Medicine,Shanghai 200040,China;Tongji Universily School of Medicine,Shanghai 200092,China;Department of Anesthesiology and Perioperative Medicine,Shanghai Fourth People's Hospital,School of Medicine,Tongji University,Shanghai 200434,China)

机构地区：[1]同济大学附属第一妇婴保健院麻醉科,上海200040 [2]同济大学医学院,上海200092 [3]同济大学附属上海市第四人民医院麻醉与围术期医学科,上海200434

出　　处：《国际麻醉学与复苏杂志》2022年第8期845-849,共5页International Journal of Anesthesiology and Resuscitation

基　　金：上海市科委医学创新研究专项(22Y11905900)。

摘　　要：目的探究不同硬膜外导管设计和脉冲速率对脉冲压力的影响.方法对国内常用的12种硬膜外导管联合5种脉冲速率(120、240、360、480、600ml/h)进行体外测压(峰值压力及脉冲平均压力).通过Pearson相关性分析比较脉冲速率与脉冲平均压力的关系,并比较不同设计两种硬膜外导管在不同脉冲速率下脉冲平均压力的差异.结果不同硬膜外导管和脉冲速率总共产生60种组合,共进行180次测压.峰值压力变化范围为1.81~14.84psi.12根导管的脉冲速率和脉冲平均压力呈高度线性正相关(r>0.8,P<0.05).末端封闭导管在各脉冲速率下所产生的脉冲平均压力均高于末端开孔导管(P<0.001);20 G导管在各脉冲速率下所产生的脉冲平均压力均高于19 G导管(P<0.05);钢丝加强导管在各脉冲速率下所产生的脉冲平均压力均高于无钢丝加强导管(P<0.05).结论脉冲平均压力与脉冲速率呈正相关,细管径、末端封闭、钢丝加强型的导管设计会增加脉冲平均压力,在使用较高脉冲速率(>360 ml/h)时,应使用粗管径的硬膜外导管以降低报警风险.Objective Compare the effect of various epidural catheter designs and delivery rates on injective pressure.Methods The pressure(peak pressure and mean pressure)was measured at five delivery rates(120,240,360,480,600 ml/h)through twelve epidural catheters.Pearson's correlation coefficients were used to assessthe delivery rate and pressure relationship,and the difference of the mean injective pressure between two catheters under various delivery rates was also compared.Results The peak pressure range between 1.81-14.84 psi.60 combinations of diferent epidural catheters and delivery rates were generated,and 180 pressure tests were performed.The pressures were correlated with delivery rates(r>0.8,P<0.05,12 catheters).The mean pressure in a close-ended catheter was significantly higher than the pressure in an open-ended catheter(P<0.05,all delivery rates),while the mean pressure in a 20 G catheter was substantially higher than the pressure in a 19 G catheter(P<0.05,all delivery rates).The mean pressure in wire-reinforced catheters was significantly higher than the pressure in non-reinforced catheters(P<0.05,all delivery rates).Conclusions High delivery rate generated high pressure.Small gauged,wire-reinforced,close-ended catheter design may increase pressure generated during the programmed intermitent epidural bolus.Higher gauged catheters may trigger occlusion alarm at high delivery rates>360 ml/h.

关 键 词：镇痛 程控间歇硬膜外脉冲 硬膜外导管 椎管内镇痛 

分 类 号：R614[医药卫生—麻醉学]