【摘要】：為了驗(yàn)證軌道式腰硬聯(lián)合套件在臨床剖宮產(chǎn)麻醉中應(yīng)用的效果,我們設(shè)計(jì)并進(jìn)行了這項(xiàng)前瞻性、隨機(jī)對照研究,比較新型的軌道式腰麻-硬膜外聯(lián)合針,針旁針(needle-beside-needle,NBN)技術(shù)和傳統(tǒng)Tophy針,針穿針(needle-though-needle,NTN)技術(shù)在剖宮產(chǎn)患者腰硬聯(lián)合麻醉(combined spinal and epidural anesthesia,CSEA)中應(yīng)用的安全性和有效性。將115例年齡18-35歲,美國麻醉醫(yī)師協(xié)會(huì)(American society of anesthesiologists,ASA)評分I-II,擇期行剖宮產(chǎn)的健康產(chǎn)婦根據(jù)隨機(jī)數(shù)表法隨機(jī)分為兩組:NBN組(n=58),應(yīng)用軌道式腰硬聯(lián)合針和NTN組(n=57),應(yīng)用普通Tophy針,在腰硬聯(lián)合麻醉下行剖宮產(chǎn)術(shù)。所有患者在入室后給予乳酸林格液800ml/h,氧流量3L/min給予鼻管吸氧,監(jiān)測并記錄患者的心電圖、無創(chuàng)血壓和脈氧。所有患者均在右側(cè)臥位接受嚴(yán)格無菌的神經(jīng)阻滯操做。NTN組使用傳統(tǒng)Tophy針,在L3-4間隙進(jìn)行硬膜外穿刺完成后根據(jù)患者身高注射重比重的5%羅哌卡因(2.0 ml 0.75%羅哌卡因+1.0ml 10%葡萄糖溶液)2-3ml進(jìn)行脊髓麻醉,最后置管并固定;NBN組使用軌道式腰硬聯(lián)合針,硬膜外針穿刺進(jìn)入硬膜外腔后先行導(dǎo)管的置入,然后通過軌道進(jìn)行腰麻穿刺,應(yīng)用同樣劑量的麻醉藥進(jìn)行脊髓麻醉,CSEA操作完成后將患者翻轉(zhuǎn)為仰臥位準(zhǔn)備手術(shù)。由一名并不知曉實(shí)驗(yàn)用藥及分組情況的護(hù)士記錄每次試驗(yàn)麻醉藥物劑量、血流動(dòng)力學(xué)指標(biāo)包括收縮壓(systolic blood pressure,SBP)、舒張壓(diastolic blood pressure,DBP)、平均動(dòng)脈壓(mean arterial pressure,MAP)、心率(heart rate,HR)、腰硬聯(lián)合麻醉操作時(shí)間、從脊髓麻醉開始到體位翻轉(zhuǎn)為仰臥位的時(shí)間間隔、硬膜外和脊髓麻醉穿刺次數(shù)、最高的麻醉平面、不良事件的發(fā)生率包括麻醉操作過程中置管失敗、硬膜外針刺破脊膜、硬膜外出血、穿刺及置管時(shí)患者的異常感覺,術(shù)中低血壓的發(fā)生,以及術(shù)后患者肢體的異常感覺、腰痛、頭痛、惡心嘔吐的發(fā)生率,并且應(yīng)用視覺模擬量表(visual analogue scale,VAS)測量并記錄麻醉科醫(yī)師和患者對這兩種技術(shù)在實(shí)際應(yīng)用中的滿意度評分。結(jié)果發(fā)現(xiàn):在NBN組中,腰硬聯(lián)合麻醉操作時(shí)間(339.71±52.78vs 364.56±79.07,P=0.049)和從脊髓麻醉開始到體位翻轉(zhuǎn)為仰臥位的時(shí)間間隔(103.76±34.52 vs 142.30±32.57,P0.001)均小于NTN組�；颊邔@兩種技術(shù)的滿意度沒有統(tǒng)計(jì)學(xué)差異,而麻醉科醫(yī)師對軌道式腰硬聯(lián)合針(NBN組)的滿意度評分較高(1[0,1.25]和1[1,2],P=0.006)。此外,與NTN組相比,NBN組在操作過程中腰麻針更加穩(wěn)定(0[0,0]和1[0,2],P0.001)。各不良事件的發(fā)生率兩組之間沒有統(tǒng)計(jì)學(xué)意義(P0.05),兩組間的麻醉藥劑量、最大感覺水平,以及椎管內(nèi)穿刺失敗的次數(shù)均無統(tǒng)計(jì)學(xué)差異(P0.05)。綜合分析結(jié)果得出結(jié)論如下:(1)與傳統(tǒng)的NTN技術(shù)相比,在腰硬聯(lián)合麻醉操作過程中腰麻針的高穩(wěn)定性是NBN技術(shù)的一大亮點(diǎn),雖然理論上可以避免操作過程中腰麻針的移動(dòng)造成脊髓的誤傷,但本試驗(yàn)結(jié)果并未證實(shí)。(2)盡管這一改良技術(shù)在本次試驗(yàn)中沒有明顯降低不良反應(yīng)的發(fā)生率,但腰硬聯(lián)合麻醉的操作時(shí)間以及從脊麻開始到將患者翻轉(zhuǎn)成仰臥位的時(shí)間明顯縮短。(3)麻醉科醫(yī)師對于該軌道式腰硬聯(lián)合麻醉針的應(yīng)用滿意度評分更高,表明NBN技術(shù)更加便于麻醉科醫(yī)師的操作,縮短了操作時(shí)間,具有很大的臨床應(yīng)用價(jià)值。
[Abstract]:In order to verify the effect of the orbital waist-hard joint kit in clinical cesarean section anesthesia, we designed and conducted this prospective, randomized controlled study comparing the new orbital waist-epidural needle, needle-bone-needle, NBN technology and traditional Tophy needle, needle-needle-needle, The safety and effectiveness of NTN technique in combined spinal cord anesthesia (CSEA) in patients with cesarean section. 115 patients aged 18-35 years old, American Society of Anestones (ASA) and I-II were randomly divided into two groups according to the random number table method: NBN group (n = 58), orbital waist hard combined needle and NTN group (n = 57), common Tophy needle was used. Under waist and hard combined anesthesia, cesarean section was performed. All patients were given lactic acid forest liquid 800ml/ h after entering the room, oxygen flow was 3L/ min, nasal tube was inhaled, the patient's electrocardiogram was monitored and recorded, and no blood pressure and pulse oxygen were created. All patients received strict sterile nerve block exercises in the right lateral position. The NTN group used the traditional Tophy needle, and after the epidural puncture was performed at the L3-4 gap, the spinal cord was anesthetized with 2-3ml of 5% rodicaine (2.0 ml 0. 75% rodicaine + 1. 0ml 10% glucose solution) with a specific gravity according to the height of the patient, the last tube was placed and fixed, and the NBN group used a track waist hard combined needle. the epidural needle is punctured into the epidural space, the placement of the leading catheter is carried out, the spinal anesthesia is performed through the track, the spinal anesthesia is performed by applying the same dose of the anesthetic, and the patient is turned into the supine position preparation operation after the CSEA operation is completed. A nurse who is not aware of the experimental medication and the packet condition records the dose of anesthetic medication per trial, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), The duration of lumbar hard combined anesthesia operation, the time interval from the beginning of spinal anesthesia to the position turning into supine position, the times of epidural and spinal anesthesia puncture, the highest anesthesia plane, the incidence of adverse events including the failure of placing tube during anesthesia operation, epidural needle puncture of the ridge membrane, Abnormal sensation of patient during epidural hemorrhage, puncture and placement, occurrence of hypotension during operation, abnormal sensation of limb after operation, lumbago, headache, incidence of nausea and vomiting, and application of visual analogue scale, VAS) measures and records the satisfaction scores of anesthesiologists and patients in the actual application. The results showed that in NBN group, the combined anesthesia operation time (339. 71, 52. 78vs 364. 56, 79. 07, P = 0.049) and the time interval from the beginning of spinal anesthesia to the supine position (103. 76 vs 34. 52 vs 142. 30, 32. 57, P0. 001) were less than the NTN group. There was no statistical difference in the satisfaction of patients with both techniques, while anesthesiologists had a higher degree of satisfaction (1[0, 1. 25] and 1[1, 2], P = 0. 006) for orbital waist hard combined needles (NBN groups). In addition, NBN group was more stable (0[0, 0] and 1[0, 2], P0.001) during operation compared with NTN group. There was no significant difference between the incidence of adverse events (P0.05), and there was no statistical difference between the two groups (P0.05). The conclusion is as follows: (1) Compared with traditional NTN technology, the high stability of lumbar anesthesia needle during lumbar hard combined anesthesia operation is one of the bright spots of NBN technology, although theoretically it can avoid the accidental injury of spinal cord caused by the movement of lumbar anesthesia needle during operation. However, the test results are not confirmed. (2) Although this improved technique did not significantly reduce the incidence of adverse reactions in this trial, the time of operation of the lumbar hard combined anesthesia and the time from the start of the ridge to the supine position were significantly shortened. and (3) the anesthesiologist has higher application satisfaction score for the track waist hard combined anesthesia needle, which indicates that the NBN technology is more convenient for the operation of the anesthesiologist, shortens the operation time and has great clinical application value.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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