柔性加强型钢丝导管在麻醉操作中硬膜外间隙置管中的应用

发布时间：2018-05-02 11:46

  本文选题：柔性加强型硬膜外导管 + 椎管内麻醉　； 参考：《广东医学》2017年17期

【摘要】：目的研究柔性加强型钢丝导管对麻醉操作中硬膜外间隙置管及并发症发生的影响,探讨其临床应用的安全性和可行性。方法选取择期腰硬联合麻醉行下腹部及下肢手术,并常规行硬膜外连续镇痛的400例成年患者,ASA分级Ⅰ~Ⅱ级,性别不限,年龄20~64岁,按照病种随机数字表法分为两组,每组200例。A组为柔性加强型硬膜外导管组,C组为传统普通导管组,两组均常规实施腰硬联合麻醉(L2~3),两组分别留置相应的硬膜外导管,术后持续硬膜外镇痛48 h,观察各组患者硬膜外用药量,患者运动阻滞功能恢复至0级的时间,改良Bromage分级,开启PCA泵后各时段伤口静息疼痛和动态疼痛的VAS评分及Ramesay镇静评分,记录两组病例在置管过程中导管置管的顺利程度、患者的触电反应、导管置入血管、回抽有血及术后下肢异常感觉、运动功能或痛觉过敏等情况与可能发生的不良反应。结果 A组、C组组硬膜外穿刺成功率分别为99%与98%,蛛网膜下腔注药成功率分别为98%与97%,组间比较差异无统计学意义(P0.05);患者在手术麻醉中收缩压(SBP)/舒张压(DBP)、心率(HR)、脉搏血氧饱和度(Sp O2)值升降变化趋势一致(P0.05);两组患者手术时间、麻醉时间、蛛网膜下腔局麻药用量、硬膜外间隙局麻药用量、出血量及术中补液量均基本一致,最后一次硬膜外给药时间,组间比较差异无统计学意义(P0.05);穿刺置管过程中A组导管置管的顺利程度高于C组(P0.05),A组调整导管方向和患者的触电反应低于C组(P0.05);A组导管置入血管和回抽有血低于C组(P0.05),组间比较差异有统计学意义(P0.05)。A组换点穿刺的病例数与C组相同(P0.05);A组术后下肢异常感觉2例(1.0%)低于C组11例(5.5%);术后镇痛期间恶心、呕吐发生率分别为A组10例(5%),C组12例(5.4%);寒战A组为1例(0.5%),C组5例(2.5%),组间比较差异无统计学意义(P0.05);综合满意度A组(99%)高于C组(90%)(P0.05)。结论柔性加强型硬膜外导管置管的顺利程度高,可改善硬膜外间隙置管质量,用于硬膜外阻滞安全有效,在整个麻醉及术后镇痛期间提高患者的综合满意度,减少并发症的发生,可在临床选用。
[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.
【作者单位】： 深圳市坪山区人民医院麻醉科;
【分类号】：R614
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本文编号：1833736