采用尖侧孔针与斜面针腰麻对剖宫产术后并发症的影响  

Comparision of using pen type fine needle and bevel needle in spinal anesthesia regarding complications after caesarean section

作　　者：姚腊梅 朱海娟 夏寅 汪胜友 李元海[3] YAO Lamei;ZHU Haijuan;XIA Yin;WANG Shengyou;LI Yuanhai(Department of Anesthesiology,Anhui Provincial Maternity&Child Health Hospital,Hefei 230001,China;Department of Anesthesiology,Anhui Provincial Children’s Hospital,Hefei 230051,China;Department of Anesthesiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽省妇幼保健院麻醉科,安徽合肥230051 [2]安徽省儿童医院麻醉科,安徽合肥230051 [3]安徽医科大学第一附属医院麻醉科,安徽合肥230022

出　　处：《中国妇幼健康研究》2023年第7期92-98,共7页Chinese Journal of Woman and Child Health Research

基　　金：合肥市卫生健康委应用医学研究项目(HWK2021yb017)。

摘　　要：目的评价采用尖侧孔针与斜面针椎管内麻醉(也称腰麻)技术对剖宫产术后并发症的影响。方法选择2022年1月至2022年7月就诊于安徽省妇幼保健院并拟在腰麻下行剖宫产术的产妇80例,根据随机数字表法分为2组,即尖侧孔针微创腰麻组(M组,n=40)和斜面针普通腰麻组(S组,n=40)。M组使用25G尖侧孔针腰麻穿刺针直接行L_(3~4)蛛网膜下腔麻醉穿刺,S组使用18G斜面硬膜外针穿破黄韧带后再使用25G尖侧孔针腰麻针穿破蛛网膜,两组针注药方向均朝向头侧。比较两组外周静脉穿刺疼痛和腰麻穿刺疼痛的视觉模拟评分(VAS)及二者的差异VAS(ΔVAS),腰麻穿刺时间、手术时间等,以及术后恢复情况、产妇满意度和住院天数。结果M组术后1周、2周腰背痛(LBP)发生率均低于S组(χ^(2)值分别为6.270、5.251,P<0.05);术后2天和术后1周穿刺点疼痛发生率低于S组(χ^(2)=4.242,P<0.05;P=0.012)。多因素Logistic回归发现腰痛病史和采用尖侧孔针腰麻是术后2周LBP发生的影响因素,OR及其95%CI值分别为9.895(1.519~64.438)、0.207(0.067~0.640);分娩次数、血红蛋白及尖侧孔针腰麻是术后2天穿刺点疼痛发生的影响因素,OR及其95%CI值分别为6.575(1.207~35.821)、0.117(0.022~0.617)、0.081(0.015~0.451)。两组穿刺时间、首次成功率、穿刺异感发生率、麻醉平面、仰卧位低血压发生率、罗哌卡因和间羟胺用量比较差异均无统计学意义(P>0.05)。结论采用尖侧孔针腰麻可以降低剖宫产术后腰痛和穿刺点疼痛的发生率,提升产妇满意度,且不影响手术进程和分娩结局。Objective To evaluate the effect of using the pen type fine needle and bevel needle in spinal anesthesia(also known as lumbar anesthesia)on complications after cesarean section.Methods A total of 80 pregnant women who were at Anhui Provincial Maternity and Child Health Hospital from January 2022 to July 2022 and were to undergo cesarean section under spinal anesthesia were selected.They were divided into the pen type fine needle used group(group M,n=40)and the combined bevel needle used group(group S,n=40)via random number method.Group M used the 25G pen type fine needle to puncture the arachnoid,Group S used the 18G bevel epidural needle to puncture the ligamentum flavum first,then punctured the arachnoid with a 25G pen type fine anesthetic needle,In both groups,the puncture point were level L3/4,the direction of injection were toward to the side of head.Visual analogue scale(VAS),VAS,lumbar puncture time,operative time,post-operative recovery,maternal satisfaction and days in hospital were compared between the two groups.Results Compared with group S,the incidence of LBP in one week and two weeks after surgery was lower in M group(χ^(2)=6.270 and 5.251,respectively,both P<0.05),the incidence of puncture site pain in two days and a week after surgery was lower in M group(χ^(2)=4.242,P<0.05.P=0.012).Multivariate logistic regression showed that having history of low back pain and using pen type fine needle in spinal anesthesia were the influencing factors for the occurrence of LBP at 2 weeks postoperatively,OR(95%CI)were 9.895(1.519-64.438),0.207(0.067-0.640),respectively.Frequency of delivery,hemoglobin,pen type fine needle in spinal anesthesia were the influencing factors of puncture site pain in two days after operation,OR(95%CI)were 6.575(1.207-35.821),0.117(0.022-0.617),0.081(0.015-0.451),respectively.There were no significant differences between the two groups in puncture time,first success rate,incidence of paresthesia,the level of anesthesia,incidence of supine hypotension,and the dosage of ropivacaine a

关 键 词：椎管内麻醉 腰痛 头痛 剖宫产 

分 类 号：R173[医药卫生—妇幼卫生保健]