本文選題：柔性加強(qiáng)型硬膜外導(dǎo)管 + 椎管內(nèi)麻醉��； 參考：《廣東醫(yī)學(xué)》2017年17期

【摘要】：目的研究柔性加強(qiáng)型鋼絲導(dǎo)管對(duì)麻醉操作中硬膜外間隙置管及并發(fā)癥發(fā)生的影響,探討其臨床應(yīng)用的安全性和可行性。方法選取擇期腰硬聯(lián)合麻醉行下腹部及下肢手術(shù),并常規(guī)行硬膜外連續(xù)鎮(zhèn)痛的400例成年患者,ASA分級(jí)Ⅰ~Ⅱ級(jí),性別不限,年齡20~64歲,按照病種隨機(jī)數(shù)字表法分為兩組,每組200例。A組為柔性加強(qiáng)型硬膜外導(dǎo)管組,C組為傳統(tǒng)普通導(dǎo)管組,兩組均常規(guī)實(shí)施腰硬聯(lián)合麻醉(L2~3),兩組分別留置相應(yīng)的硬膜外導(dǎo)管,術(shù)后持續(xù)硬膜外鎮(zhèn)痛48 h,觀察各組患者硬膜外用藥量,患者運(yùn)動(dòng)阻滯功能恢復(fù)至0級(jí)的時(shí)間,改良Bromage分級(jí),開啟PCA泵后各時(shí)段傷口靜息疼痛和動(dòng)態(tài)疼痛的VAS評(píng)分及Ramesay鎮(zhèn)靜評(píng)分,記錄兩組病例在置管過程中導(dǎo)管置管的順利程度、患者的觸電反應(yīng)、導(dǎo)管置入血管、回抽有血及術(shù)后下肢異常感覺、運(yùn)動(dòng)功能或痛覺過敏等情況與可能發(fā)生的不良反應(yīng)。結(jié)果 A組、C組組硬膜外穿刺成功率分別為99%與98%,蛛網(wǎng)膜下腔注藥成功率分別為98%與97%,組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);患者在手術(shù)麻醉中收縮壓(SBP)/舒張壓(DBP)、心率(HR)、脈搏血氧飽和度(Sp O2)值升降變化趨勢(shì)一致(P0.05);兩組患者手術(shù)時(shí)間、麻醉時(shí)間、蛛網(wǎng)膜下腔局麻藥用量、硬膜外間隙局麻藥用量、出血量及術(shù)中補(bǔ)液量均基本一致,最后一次硬膜外給藥時(shí)間,組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);穿刺置管過程中A組導(dǎo)管置管的順利程度高于C組(P0.05),A組調(diào)整導(dǎo)管方向和患者的觸電反應(yīng)低于C組(P0.05);A組導(dǎo)管置入血管和回抽有血低于C組(P0.05),組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。A組換點(diǎn)穿刺的病例數(shù)與C組相同(P0.05);A組術(shù)后下肢異常感覺2例(1.0%)低于C組11例(5.5%);術(shù)后鎮(zhèn)痛期間惡心、嘔吐發(fā)生率分別為A組10例(5%),C組12例(5.4%);寒戰(zhàn)A組為1例(0.5%),C組5例(2.5%),組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);綜合滿意度A組(99%)高于C組(90%)(P0.05)。結(jié)論柔性加強(qiáng)型硬膜外導(dǎo)管置管的順利程度高,可改善硬膜外間隙置管質(zhì)量,用于硬膜外阻滯安全有效,在整個(gè)麻醉及術(shù)后鎮(zhèn)痛期間提高患者的綜合滿意度,減少并發(fā)癥的發(fā)生,可在臨床選用。
[Abstract]:Objective to study the effect of flexible reinforced steel wire catheter on epidural space catheterization and complications during anesthesia, and to explore the safety and feasibility of its clinical application. Methods 400 adult patients undergoing lower abdomen and lower extremity operation under combined spinal-epidural anesthesia and routine epidural continuous analgesia were divided into two groups according to the random number table method. Each group (200 cases) was treated with flexible and enhanced epidural catheter group (group C). The two groups were treated with combined spinal-epidural anesthesia (L2) and epidural catheterization, and the corresponding epidural catheters were placed respectively in the two groups. Postoperative continuous epidural analgesia was performed for 48 hours. The dosage of epidural analgesia, the time of recovery of motor block function to grade 0, the modified Bromage grade, the VAS score and Ramesay sedation score of rest pain and dynamic pain after PCA pump were observed. The degree of success of catheterization in both groups, the electroshock response of patients, the placement of blood vessel, the abnormal feeling of lower extremity, motor function or hyperalgesia, and the possible adverse reactions were recorded in the two groups. Results the success rates of epidural puncture and subarachnoid injection in group A and C were 99% and 98%, respectively. There was no significant difference between the two groups (P 0.05). The change trend of pulse oxygen saturation and Sp O _ 2 value was the same as that of P0.05.The operation time of the two groups, The time of anesthesia, the dosage of local anesthetic in subarachnoid space, the dosage of local anesthetic in epidural space, the amount of blood loss and the amount of fluid rehydration during operation were basically the same. There was no significant difference between the two groups (P 0.05), the smooth degree of catheterization in group A was higher than that in group C (P 0.05) and the electroshock response of patients in group A was lower than that in group C (P 0.05). There was significant difference between group C and group C (P 0.05). The number of patients with point change puncture in group A was significantly lower than that in group C (n = 2, abnormal sensation of lower limb in group C was 1.0) and that in group A was lower than that in group C (n = 11), nausea during postoperative analgesia. The incidence of vomiting in group A (n = 10) and group C (n = 12) was 5.40.The incidence of vomiting in group A (n = 1) was 0.5%, and in group C (n = 5) there was no significant difference (P 0.05); the comprehensive satisfaction of group A (n = 99) was higher than that of group C (n = 90). Conclusion flexible and enhanced epidural catheterization can improve the quality of epidural space catheterization and improve the safety and effectiveness of epidural block. It can improve the comprehensive satisfaction of patients during the whole period of anesthesia and postoperative analgesia. Reduce the occurrence of complications, can be selected in clinical.
【作者單位】： 深圳市坪山區(qū)人民醫(yī)院麻醉科;
【分類號(hào)】：R614
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本文編號(hào)：1833736