轨道式腰硬联合套件在剖宫产腰硬联合麻醉中的应用

发布时间：2018-10-25 10:32

【摘要】：为了验证轨道式腰硬联合套件在临床剖宫产麻醉中应用的效果,我们设计并进行了这项前瞻性、随机对照研究,比较新型的轨道式腰麻-硬膜外联合针,针旁针(needle-beside-needle,NBN)技术和传统Tophy针,针穿针(needle-though-needle,NTN)技术在剖宫产患者腰硬联合麻醉(combined spinal and epidural anesthesia,CSEA)中应用的安全性和有效性。将115例年龄18-35岁,美国麻醉医师协会(American society of anesthesiologists,ASA)评分I-II,择期行剖宫产的健康产妇根据随机数表法随机分为两组:NBN组(n=58),应用轨道式腰硬联合针和NTN组(n=57),应用普通Tophy针,在腰硬联合麻醉下行剖宫产术。所有患者在入室后给予乳酸林格液800ml/h,氧流量3L/min给予鼻管吸氧,监测并记录患者的心电图、无创血压和脉氧。所有患者均在右侧卧位接受严格无菌的神经阻滞操做。NTN组使用传统Tophy针,在L3-4间隙进行硬膜外穿刺完成后根据患者身高注射重比重的5%罗哌卡因(2.0 ml 0.75%罗哌卡因+1.0ml 10%葡萄糖溶液)2-3ml进行脊髓麻醉,最后置管并固定;NBN组使用轨道式腰硬联合针,硬膜外针穿刺进入硬膜外腔后先行导管的置入,然后通过轨道进行腰麻穿刺,应用同样剂量的麻醉药进行脊髓麻醉,CSEA操作完成后将患者翻转为仰卧位准备手术。由一名并不知晓实验用药及分组情况的护士记录每次试验麻醉药物剂量、血流动力学指标包括收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、腰硬联合麻醉操作时间、从脊髓麻醉开始到体位翻转为仰卧位的时间间隔、硬膜外和脊髓麻醉穿刺次数、最高的麻醉平面、不良事件的发生率包括麻醉操作过程中置管失败、硬膜外针刺破脊膜、硬膜外出血、穿刺及置管时患者的异常感觉,术中低血压的发生,以及术后患者肢体的异常感觉、腰痛、头痛、恶心呕吐的发生率,并且应用视觉模拟量表(visual analogue scale,VAS)测量并记录麻醉科医师和患者对这两种技术在实际应用中的满意度评分。结果发现:在NBN组中,腰硬联合麻醉操作时间(339.71±52.78vs 364.56±79.07,P=0.049)和从脊髓麻醉开始到体位翻转为仰卧位的时间间隔(103.76±34.52 vs 142.30±32.57,P0.001)均小于NTN组。患者对这两种技术的满意度没有统计学差异,而麻醉科医师对轨道式腰硬联合针(NBN组)的满意度评分较高(1[0,1.25]和1[1,2],P=0.006)。此外,与NTN组相比,NBN组在操作过程中腰麻针更加稳定(0[0,0]和1[0,2],P0.001)。各不良事件的发生率两组之间没有统计学意义(P0.05),两组间的麻醉药剂量、最大感觉水平,以及椎管内穿刺失败的次数均无统计学差异(P0.05)。综合分析结果得出结论如下:(1)与传统的NTN技术相比,在腰硬联合麻醉操作过程中腰麻针的高稳定性是NBN技术的一大亮点,虽然理论上可以避免操作过程中腰麻针的移动造成脊髓的误伤,但本试验结果并未证实。(2)尽管这一改良技术在本次试验中没有明显降低不良反应的发生率,但腰硬联合麻醉的操作时间以及从脊麻开始到将患者翻转成仰卧位的时间明显缩短。(3)麻醉科医师对于该轨道式腰硬联合麻醉针的应用满意度评分更高,表明NBN技术更加便于麻醉科医师的操作,缩短了操作时间,具有很大的临床应用价值。
[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.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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