【摘要】：目的；了解腰俞穴的解剖層次及相鄰結(jié)構(gòu),探討腰俞穴麻醉的作用原理。對(duì)比觀察復(fù)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(diǎn)和缺點(diǎn),指導(dǎo)臨床麻醉藥物的選擇。 方法：第一部分：對(duì)20具成人尸體標(biāo)本(男11具,女9具)完整的骶尾部進(jìn)行逐層解剖,觀察腰俞穴內(nèi)部構(gòu)成、局部結(jié)構(gòu)與其相毗鄰組織結(jié)構(gòu)及關(guān)系,予以記錄和分析。第二部分：臨床隨機(jī)選取需行肛腸手術(shù)治療的患者60例,分為試驗(yàn)組30例和對(duì)照組30例。試驗(yàn)組方法為采用15m1復(fù)方鹽酸利多卡因注射液+5m1注射用水進(jìn)行腰俞穴麻醉；對(duì)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(yīng)、起效、持續(xù)時(shí)間,術(shù)中肛門松弛、追加麻藥、肛門疼痛情況,以及術(shù)后肛緣水腫、疼痛及尿潴留情況,詳細(xì)記錄各組數(shù)據(jù),并對(duì)各組數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,探討兩種麻醉藥物各自的優(yōu)缺點(diǎn)。 結(jié)果：第一部分：對(duì)選取的成人標(biāo)本的骶尾部進(jìn)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(cè)韌帶,可見骶裂孔內(nèi)有層薄膜,薄膜下方(《腧穴學(xué)》定義腰俞穴的位置)可見一層黃色脂肪結(jié)締組織,緊貼于骶裂孔前壁,將骶尾神經(jīng)、終絲及大量椎內(nèi)靜脈叢包裹其中,并通過(guò)大量結(jié)締組織纖維束緊密連接且固定于骶裂孔前壁。第二部分：復(fù)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(shí)間、術(shù)中肛門肌松狀況、術(shù)中術(shù)后鎮(zhèn)痛、術(shù)后水腫及尿潴留均具有統(tǒng)計(jì)學(xué)意義(P0.05),存在差異性；而兩組病例麻醉不良反應(yīng)、起效時(shí)間、術(shù)中追加麻藥量情況無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),不存在差異性。 結(jié)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(jié)締組織,并將骶尾神經(jīng)、終絲及大量椎內(nèi)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(jié)締組織及其相鄰的筋膜綜合作用的結(jié)果。第二部分：復(fù)方鹽酸利多卡因較傳統(tǒng)鹽酸利多卡因在麻醉持續(xù)時(shí)間、術(shù)中肛門肌松狀況、術(shù)中術(shù)后鎮(zhèn)痛、術(shù)后水腫及尿潴留等方面更具優(yōu)勢(shì)。
[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(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

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