腰俞穴局部解剖及复方盐酸利多卡因腰俞穴注射在肛肠手术中的临床观察

发布时间：2018-10-26 08:30

【摘要】：目的；了解腰俞穴的解剖层次及相邻结构,探讨腰俞穴麻醉的作用原理。对比观察复方盐酸利多卡因和盐酸利多卡因腰俞穴麻醉在临床中各自的优点和缺点,指导临床麻醉药物的选择。方法：第一部分：对20具成人尸体标本(男11具,女9具)完整的骶尾部进行逐层解剖,观察腰俞穴内部构成、局部结构与其相毗邻组织结构及关系,予以记录和分析。第二部分：临床随机选取需行肛肠手术治疗的患者60例,分为试验组30例和对照组30例。试验组方法为采用15m1复方盐酸利多卡因注射液+5m1注射用水进行腰俞穴麻醉；对照组采用的方法为15ml盐酸利多卡因注射液+5m1注射用水腰俞穴麻醉。观察两组患者麻醉不良反应、起效、持续时间,术中肛门松弛、追加麻药、肛门疼痛情况,以及术后肛缘水肿、疼痛及尿潴留情况,详细记录各组数据,并对各组数据进行统计学分析,探讨两种麻醉药物各自的优缺点。结果：第一部分：对选取的成人标本的骶尾部进行逐层分离解剖,切开皮肤及皮下脂肪,剥离臀大肌,显露骶尾部深筋膜及骶尾背侧韧带,可见骶裂孔内有层薄膜,薄膜下方(《腧穴学》定义腰俞穴的位置)可见一层黄色脂肪结缔组织,紧贴于骶裂孔前壁,将骶尾神经、终丝及大量椎内静脉丛包裹其中,并通过大量结缔组织纤维束紧密连接且固定于骶裂孔前壁。第二部分：复方盐酸利多卡因组与传统盐酸利多卡因组相比较,麻醉持续时间、术中肛门肌松状况、术中术后镇痛、术后水肿及尿潴留均具有统计学意义(P0.05),存在差异性；而两组病例麻醉不良反应、起效时间、术中追加麻药量情况无统计学意义(P0.05),不存在差异性。结论：第一部分：腰俞穴位置正下方紧附一透明薄膜,薄膜下紧贴一层黄色结缔组织,并将骶尾神经、终丝及大量椎内静脉丛包裹其中,且固定于骶管裂孔前壁；腰俞穴麻醉的产生可能是针刺得气与黄色脂肪包裹的结缔组织及其相邻的筋膜综合作用的结果。第二部分：复方盐酸利多卡因较传统盐酸利多卡因在麻醉持续时间、术中肛门肌松状况、术中术后镇痛、术后水肿及尿潴留等方面更具优势。
[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.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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