腰俞穴局部解剖及復方鹽酸利多卡因腰俞穴注射在肛腸手術中的臨床觀察
發(fā)布時間：2018-10-26 08:30
【摘要】：目的；了解腰俞穴的解剖層次及相鄰結構,探討腰俞穴麻醉的作用原理。對比觀察復方鹽酸利多卡因和鹽酸利多卡因腰俞穴麻醉在臨床中各自的優(yōu)點和缺點,指導臨床麻醉藥物的選擇。 方法：第一部分：對20具成人尸體標本(男11具,女9具)完整的骶尾部進行逐層解剖,觀察腰俞穴內部構成、局部結構與其相毗鄰組織結構及關系,予以記錄和分析。第二部分：臨床隨機選取需行肛腸手術治療的患者60例,分為試驗組30例和對照組30例。試驗組方法為采用15m1復方鹽酸利多卡因注射液+5m1注射用水進行腰俞穴麻醉；對照組采用的方法為15ml鹽酸利多卡因注射液+5m1注射用水腰俞穴麻醉。觀察兩組患者麻醉不良反應、起效、持續(xù)時間,術中肛門松弛、追加麻藥、肛門疼痛情況,以及術后肛緣水腫、疼痛及尿潴留情況,詳細記錄各組數(shù)據(jù),并對各組數(shù)據(jù)進行統(tǒng)計學分析,探討兩種麻醉藥物各自的優(yōu)缺點。 結果：第一部分：對選取的成人標本的骶尾部進行逐層分離解剖,切開皮膚及皮下脂肪,剝離臀大肌,顯露骶尾部深筋膜及骶尾背側韌帶,可見骶裂孔內有層薄膜,薄膜下方(《腧穴學》定義腰俞穴的位置)可見一層黃色脂肪結締組織,緊貼于骶裂孔前壁,將骶尾神經(jīng)、終絲及大量椎內靜脈叢包裹其中,并通過大量結締組織纖維束緊密連接且固定于骶裂孔前壁。第二部分：復方鹽酸利多卡因組與傳統(tǒng)鹽酸利多卡因組相比較,麻醉持續(xù)時間、術中肛門肌松狀況、術中術后鎮(zhèn)痛、術后水腫及尿潴留均具有統(tǒng)計學意義(P0.05),存在差異性；而兩組病例麻醉不良反應、起效時間、術中追加麻藥量情況無統(tǒng)計學意義(P0.05),不存在差異性。 結論：第一部分：腰俞穴位置正下方緊附一透明薄膜,薄膜下緊貼一層黃色結締組織,并將骶尾神經(jīng)、終絲及大量椎內靜脈叢包裹其中,且固定于骶管裂孔前壁；腰俞穴麻醉的產(chǎn)生可能是針刺得氣與黃色脂肪包裹的結締組織及其相鄰的筋膜綜合作用的結果。第二部分：復方鹽酸利多卡因較傳統(tǒng)鹽酸利多卡因在麻醉持續(xù)時間、術中肛門肌松狀況、術中術后鎮(zhèn)痛、術后水腫及尿潴留等方面更具優(yōu)勢。
[Abstract]:Objective: to understand the anatomical level and adjacent structure of Yaoshu point and to explore the mechanism of anaesthesia at Yaoshu point. To compare the advantages and disadvantages of compound lidocaine hydrochloride and lidocaine hydrochloride in clinical anaesthesia and guide the choice of clinical anesthetic. Methods: in the first part, 20 adult cadavers (11 males and 9 females) were dissected from sacrococcyx, the internal structure of Yaoshu point, the local structure and its adjacent tissue structure and relationship were observed and analyzed. The second part: 60 patients with anorectal surgery were randomly divided into trial group (n = 30) and control group (n = 30). The experimental group was anesthetized with 15m1 compound lidocaine hydrochloride injection 5m1 and the control group with 15ml lidocaine hydrochloride injection 5m1 injection. The adverse reactions, onset, duration, anus relaxation, anus pain, anus edema, pain and urinary retention were observed in two groups, and the data of each group were recorded in detail. The data of each group were analyzed statistically, and the advantages and disadvantages of the two kinds of anesthetics were discussed. Results: the first part: the sacrococcyx of the selected adult specimen was dissected layer by layer, the skin and subcutaneous fat were cut off, the gluteus maximus muscle was stripped, and the sacrococcygeal deep fascia and dorsal sacrococcygeal ligament were exposed. A layer of yellow fat connective tissue can be seen below the film ("acupoint theory" defines the position of Yaoshu point), which is close to the anterior wall of the sacral hiatus and covers the sacrococcygeal nerve, filaments and a large number of intraspinal venous plexuses. A large number of connective tissue bundles are tightly connected and fixed to the anterior wall of the sacral fissure. The second part: compared with the traditional lidocaine hydrochloride group, the duration of anesthesia, anus muscle relaxation, postoperative analgesia, postoperative edema and urinary retention were statistically significant (P0.05). There are differences; However, there was no significant difference between the two groups (P0.05) in the adverse reaction, onset time and the amount of additional anesthetic in the two groups (P0.05). Conclusion: in the first part, a transparent film was attached directly below the Yaoshu point, and a layer of yellow connective tissue was attached under the film. The sacrococcygeal nerve, terminal filament and a large number of internal vertebral venous plexus were encapsulated in the film and fixed on the anterior wall of the sacral canal fissure. The anaesthesia at Yaoshu point may be the result of the combined effect of acupuncture on the connective tissue wrapped in yellow fat and its adjacent fascia. The second part: the compound lidocaine hydrochloride has more advantages than the traditional lidocaine hydrochloride in the duration of anesthesia, anus muscle relaxation, postoperative analgesia, postoperative edema and urinary retention.
【學位授予單位】：成都中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614
本文編號：2295150
[Abstract]:Objective: to understand the anatomical level and adjacent structure of Yaoshu point and to explore the mechanism of anaesthesia at Yaoshu point. To compare the advantages and disadvantages of compound lidocaine hydrochloride and lidocaine hydrochloride in clinical anaesthesia and guide the choice of clinical anesthetic. Methods: in the first part, 20 adult cadavers (11 males and 9 females) were dissected from sacrococcyx, the internal structure of Yaoshu point, the local structure and its adjacent tissue structure and relationship were observed and analyzed. The second part: 60 patients with anorectal surgery were randomly divided into trial group (n = 30) and control group (n = 30). The experimental group was anesthetized with 15m1 compound lidocaine hydrochloride injection 5m1 and the control group with 15ml lidocaine hydrochloride injection 5m1 injection. The adverse reactions, onset, duration, anus relaxation, anus pain, anus edema, pain and urinary retention were observed in two groups, and the data of each group were recorded in detail. The data of each group were analyzed statistically, and the advantages and disadvantages of the two kinds of anesthetics were discussed. Results: the first part: the sacrococcyx of the selected adult specimen was dissected layer by layer, the skin and subcutaneous fat were cut off, the gluteus maximus muscle was stripped, and the sacrococcygeal deep fascia and dorsal sacrococcygeal ligament were exposed. A layer of yellow fat connective tissue can be seen below the film ("acupoint theory" defines the position of Yaoshu point), which is close to the anterior wall of the sacral hiatus and covers the sacrococcygeal nerve, filaments and a large number of intraspinal venous plexuses. A large number of connective tissue bundles are tightly connected and fixed to the anterior wall of the sacral fissure. The second part: compared with the traditional lidocaine hydrochloride group, the duration of anesthesia, anus muscle relaxation, postoperative analgesia, postoperative edema and urinary retention were statistically significant (P0.05). There are differences; However, there was no significant difference between the two groups (P0.05) in the adverse reaction, onset time and the amount of additional anesthetic in the two groups (P0.05). Conclusion: in the first part, a transparent film was attached directly below the Yaoshu point, and a layer of yellow connective tissue was attached under the film. The sacrococcygeal nerve, terminal filament and a large number of internal vertebral venous plexus were encapsulated in the film and fixed on the anterior wall of the sacral canal fissure. The anaesthesia at Yaoshu point may be the result of the combined effect of acupuncture on the connective tissue wrapped in yellow fat and its adjacent fascia. The second part: the compound lidocaine hydrochloride has more advantages than the traditional lidocaine hydrochloride in the duration of anesthesia, anus muscle relaxation, postoperative analgesia, postoperative edema and urinary retention.
【學位授予單位】：成都中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614
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