增效硬膜外麻醉用于剖宫产术患者的效果:单中心回顾性观察性研究  

Efficacy of enhanced epidural anesthesia in patients undergoing cesarean section:a single-center retrospective observational study

作　　者：杨路加 郭永馨 刘艳红[1] 刘靖[1] 孙立[1] 王红[1] 曹江北[1] 米卫东[1] 张宏[1] Yang Lujia;Guo Yongxin;Liu Yanhong;Liu Jing;Sun Li;Wang Hong;Cao Jiangbei;Mi Weidong;Zhang Hong(Department of Anesthesiology,First Medical Center,PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心麻醉科,北京100853

出　　处：《中华麻醉学杂志》2023年第9期1097-1102,共6页Chinese Journal of Anesthesiology

基　　金：国家重点研发计划(2018YFC2001905)。

摘　　要：目的回顾性分析增效硬膜外麻醉用于剖宫产术患者的效果。方法回顾性收集2008年8月至2021年12月本院行剖宫产术患者的病历资料,记录麻醉操作方式、药物用量、起效时间、阻滞平面、作用效果、补救用药及操作相关并发症。增效硬膜外麻醉主要包括以下要点:①硬膜外穿刺针原位旋转测试负压确定针尖位置;②通过硬膜外穿刺针给药后置管。对有硬膜外操作资质的134名麻醉医师进行问卷调查,收集该技术在临床中的应用情况。问卷内容包括硬膜外操作中是否常规转针、转针方向、穿刺针给药剂量占总剂量的百分比。结果纳入10054例硬膜外麻醉(10016例)和硬膜外麻醉中转全麻(38例)患者,硬膜外局麻药物使用量18(15,20)ml;可查阅到阻滞平面有4287例,其中阻滞平面T6-8水平比率86.84%;从开始麻醉穿刺到手术切皮时间为25(20,30)min。硬膜外麻醉效果不佳中转全麻16例(0.159%);10016例硬膜外麻醉患者中,术中辅助用药925例(9.235%);患者均未见全脊麻发生,因穿刺原因或转针导致硬膜外穿孔25例(0.248%),局麻药中毒4例(0.039%),术后神经损伤3例(0.030%),硬膜外给药后30 min内因血流动力学不稳定需要使用血管活性药物进行干预的患者142例(1.412%)。问卷调查:硬膜外腔内旋转穿刺针的麻醉医师比率为85.1%,置管前通过硬膜外穿刺针注射局麻药物剂量大于总剂量50%的麻醉医师比率为84.2%。结论增效硬膜外麻醉可为剖宫产术患者提供有效的麻醉效果,且未明显增加硬膜外操作相关并发症发生风险。Objective To retrospectively review the efficacy of enhanced epidural anesthesia in the patients undergoing cesarean section.Methods The data from patients who underwent cesarean section in our hospital from August 2008 to December 2021 were retrospectively collected.The method of epidural anesthesia,drug dosage,onset time,blocking level,anesthesia effect,remedial medication,and complications related to the method were recorded.The main points of enhanced epidural anesthesia included:①test negative pressure by rotating the epidural puncture needle in situ to determine the position of the needle tip;②catheterization after administering local anesthetic through epidural puncture needle to assess the clinical application of this technique.A questionnaire survey was conducted in 134 anesthesiologists with qualifications for epidural procedures.The questionnaire addressed whether to perform routine needle rotation during epidural procedures,direction of needle rotation,and the percentage of the dosage of local anesthetic administered through puncture needle.Results A total of 10054 patients received epidural anesthesia(10016 cases)and switched to general anesthesia because of poor epidural effect or intraoperative emergencies(38 cases)were enrolled.The consumption of local anesthetics for epidural anesthesia was 18(15,20)ml.There were 7287 cases with block plane records,of which the ratio of the block level reached T6-8 was 86.84%.The time from the beginning of anesthesia to skin incision was 25(20,30)min.Sixteen patients(0.159%)switched to general anesthesia because of poor epidural effect.Among 10016 patients underwent epidural anesthesia,925 patients(9.235%)received intravenous adjunctive drugs.No patients experienced total spinal anesthesia,25 patients(0.248%)had epidural perforation due to puncture or needle rotation,and 4 cases(0.039%)local anesthetic intoxication,3 cases(0.030%)postoperative nerve injury,and 142 patients(1.412%)requiring intervention with vasoactive drugs due to hemodynamic instability with

关 键 词：麻醉 产科 麻醉 硬膜外 回顾性研究 

分 类 号：R614[医药卫生—麻醉学] R719.8[医药卫生—外科学]