大鼠蛛网膜下腔和硬膜外腔阻滞模型的建立

目的建立大鼠蛛网膜下腔和硬膜外腔阻滞模型。方法将132只SD大鼠分成蛛网膜下腔阻滞模型组（S组,n=77）和硬膜外腔阻滞模型组（E组,n=55）。S组是将大鼠麻醉后,在背部L3-L4间隙处剪开椎间隙的棘上韧带和棘间韧带后将聚乙烯导管置入蛛网膜下腔。E组是将大鼠麻醉后,分离T13-L1棘突旁肌肉,直视下通过椎间孔将聚乙烯导管通过椎间孔置入硬膜外腔。结果蛛网膜下腔模型组存活率100%,成功率80.5%;硬膜外腔模型组存活率100%,成功率70.9%。结论改进的大鼠蛛网膜下腔阻滞模型及硬膜外腔阻滞模型的制备简便易行,成功率高,创伤小。     

多哥人腰痛阻滞治疗初步探讨

1993年作者在西非洲多哥共和国首都洛美市Clinique Bor Secours援外医疗时对腰痛患者施行阻滞镇痛179例。现报告如下。 1 治疗方法常规硬膜外穿刺,选L_1～L_2或L_2～L_3椎间隙置硬膜外导管2～3cm。椎旁阻滞取L_1或L_2棘突上缘水平线,距后正中线3～3.5cm处     

胸4～5椎间隙直视下硬膜外头端置管建立上胸段硬膜外阻滞大鼠模型

目的为上胸段硬膜外阻滞的动物试验研究提供经济、稳定、可靠的模型。方法以大鼠为研究对象,经胸4～5椎间隙,直视下向头端于硬膜外腔置入经拉撕等处理后的临床用硬膜外导管,采用椎旁肌肉缝扎导管,皮下隧道预留缓冲长度等方法固定导管。48 h后大鼠硬膜外腔注入美蓝100μL/kg,尸检鉴定模型成功和药液的分布范围。结果置管48 h后的成功率为85.8%,硬膜外腔的感染率为0,导管脱出几率5%。结论本研究证实了经胸4～5椎间隙直视下头端置管建立上胸段硬膜外阻滞大鼠模型的可行性,并具有损伤小、稳定性好、成功率高、费用低及周期短等优点。     

硬膜外阻滞穿刺角度和置管长度的探讨(附2000例临床总结)

目的 :探讨硬膜外阻滞穿刺一针成功率 ,提高硬膜外阻滞临床效果。方法 :在硬膜外穿刺成功后 ,测量穿刺针针体和侧中线皮肤的夹角度 ,进针深度 ,硬膜外腔留置导管的长度。结果 :穿刺针针体和皮肤的夹角主要与棘突倾斜度有关 ,进针深度和患者性别、身高、体重有关 ,硬膜外腔留置导管不宜超过 4cm。结论 :参照穿刺点不同角度、深度 ,可显著提高穿刺成功率 ,缩短穿刺时间 ,减少患者痛苦及并发症 ,硬外腔留置导管最好 2～ 3cm。     

硬膜外阻滞麻醉导管断裂1例

患者,女,30岁,硬脊膜外腔阻滞麻醉导管残留3天就诊。患者3天前于外院硬膜外阻滞麻醉下行剖宫产术。手术顺利,术后拔除麻醉导管时,导管断裂,残留于硬脊外腔,自觉腰部轻微疼痛不适。行CT扫描提示:L1～L2椎体所在硬脊膜外腔有一长达6cm麻醉导管。查体:生命体征平稳,神经系统未引出病理反射征。局麻下行硬脊膜外导管取出来,咬掉L1～L2椎体部分椎板,从椎间孔处进入硬膜外腔,探查并取出一长6cm麻醉导管,患者痊愈出院。　　硬膜外腔阻滞麻醉导管断裂较少见。分析其原因为:1麻醉导管插入过深(一般3～5cm)。2拔除导管时操作过快过猛或拔除导管时,…     

硬膜外腔置管中硬膜外导管折断1例

患者　男,４５岁。因患Ｌ４,５椎间盘突出症行Ｌ４,５半椎板切除和髓核摘除术。选择Ｌ１～２间隙行硬膜外麻醉,用１８Ｇ穿刺针和直入法穿刺,穿过黄韧带进入硬膜外腔,测量硬膜外腔深度为５ｃｍ,向脚端置入一次性硬膜外导管。导管通过穿刺针至１３ｃｍ处受阻,多次转动穿刺针,导管仍不能置入,于是退管重新穿刺。左手固定穿刺针,右手轻拉导管,感觉阻力大,稍用力,导管被拉出来,但前端被针尖割断３ｃｍ残留硬膜外腔内。随即更换Ｔ１,２～Ｌ１重新穿刺向头端置管,置管通畅,出现麻醉平面后,不改变体位,仍在右侧位下手术。术中术…     

置管方向不同硬膜外麻醉用于剖宫产手术临床观察

目的 比较T12～L1硬膜外穿刺向头方向置管与T12～L1硬膜外穿刺向尾方向置管用于剖宫产手术麻醉效果.方法 选择ASA Ⅰ～Ⅱ级患者90例于硬膜外施行剖宫产手术,随机双盲均分为两组,A组用T12～L1硬膜外穿刺向头置管罗哌卡因8 ml,B组用T12～L1 硬膜外向尾置管罗哌卡因8 ml. 术中连续监测呼吸,循环状况评估麻醉效应和维持时间.结果 两组胸、腰段阻滞平面和骶神经支配区域,会阴部牵拉反应有明显差异.结论 T12～L1施行硬膜外穿刺置管方向不同,尾部置管患者会阴部牵拉反应低,血压明显减少.     

克服低位硬膜外腔阻滞穿刺置管困难的一些方法

<正> 连续低位硬膜外腔阻滞穿刺时常采用直入法。有时会遇到放置硬膜外导管困难。我院1998年～2000年采用改良的置管方法处理多例患者,效果良好。1 穿刺置管所遇到的困难及方法的改良 患者取侧卧位,常规消毒、铺巾,使用16或18G,10cm长硬膜外穿刺针,行低位硬膜外腔穿刺术。确定针尖已进入硬膜外腔,然后经针蒂置入硬膜外导管。有时会出现以下情     

全麻-硬膜外联合麻醉在胸部及上腹部手术中的应用

我们对胸部及上腹部手术的 80例病人应用全麻复合硬膜外腔神经阻滞麻醉 ,效果满意 ,现报道如下。1　资料和方法1.1　一般资料　胸部及上腹部手术的病人 80例 ,年龄 2 6～ 6 8岁 ,ASAⅠ～Ⅱ级 ,随机分为两组。复合组 (N =4 0 )行全麻复合硬膜外腔神经阻滞方法 ;对照组 (N =4 0 )单独使用全麻。复合组选T5～ 6 (胸部手术 )或T8～ 9(上腹部手术 )间隙行硬膜外腔穿刺置管后固定导管 ,隔离膜封闭穿刺部位 ,硬膜外腔注入 1.3%利多卡因试验量 5ml,全量 10ml左右 ,测定麻醉阻滞平面。两组均在力月西、芬太尼、福罗、琥珀胆碱诱导下行气管内插管 ,…     

成人膜椎韧带与硬膜下腔阻滞的关联

在硬膜外腔,成人膜椎韧带(Meningovertebral Ligaments)从前面把硬脊膜连于后纵韧带或椎体后表面,从后面则把硬脊膜连于椎板或黄韧带。换言之,膜椎韧带广泛分布在硬脊膜周围。背部的膜椎韧带与椎板或黄韧带附着处多偏于头侧,与硬脊膜附着处多偏于尾侧,整体上膜椎韧带的走向呈前下后上,少部分韧带呈前上后下走向。手术显微镜下,膜椎韧带与硬脊膜附着处紧密结合,钝性剥离可见膜椎韧带的纤维束与硬脊膜后壁相延续,显然,参与其构成。膜椎韧带的这种解剖结构,在硬膜外麻醉置管的过程中,会影响到硬膜外导管的走向。而细长坚硬的硬膜外导管通常向上或向下需要置入3-5cm,在置入导管的过程中,也会牵扯到膜椎韧带。基于以上两种情况,硬脊膜后壁很容易被撕脱。从而,原来与膜椎韧带连接的硬脊膜意外变薄甚至产生缺口,硬膜外腔注入的局麻药通过直接扩散抑或毛细管效应进入硬脊膜下腔,从而造成异常广泛的阻滞即硬脊膜下腔阻滞或硬脊膜下隙阻滞。     

神经刺激器辅助下腰丛联合坐骨神经阻滞在老年患者下肢手术中的应用

目的 比较神经刺激器辅助下腰丛联合坐骨神经阻滞与硬膜外麻醉在老年患者下肢手术中的麻醉效果.方法 46例下肢手术的老年患者随机分为硬膜外麻醉组(E组,n=25)和腰丛联合坐骨神经阻滞组(N组,n=21)两组.E组行连续硬膜外麻醉,硬膜外腔向头侧置管,给予1％利多卡因+ 0.375％罗哌卡因10～14 ml;N组行神经刺...     

先天性静止性夜盲模式大鼠基础生理值的测定

目的:对本实验室首先发现并培育的自发性先天性静止性夜盲(CSNB)大鼠的主要脏器及血液、生化指标进行检测. 方法:随机选取出生13～15 wk的第11,12代CSNB大鼠通过视网膜电图鉴定后,抽取静脉血进行血清生化相关指标的检测,并对其重要脏器进行准确称量. 结果:CSNB大鼠脏器质量在雌雄之间除脾脏、肾上腺、脑垂体外,其余均存在显著差异(P＜0.05);脏器系数大脑、小脑、脑干雌雄间存在非常显著差异(P＜0.01);生化指标葡萄糖、总胆固醇和白蛋白在雌性大于雄性,丙氨酸基转换酶、天门冬氨酸基转换酶、碱性磷酸酶、尿素氮、肌酐、甘油三酯和总蛋白在雌性小于雄性;血电解质K ,Na ,离子钙(iCa)在雄性大于雌性, 雌性的Cl-值高,但无差异. 结论:CSNB大鼠基本生理学和生物化学参数均在正常范围内,其中一些参数在CSNB大鼠性别之间存在差异,但是与正常对照SD大鼠之间只有个别参数有差异. CSNB大鼠为遗传性视网膜疾病的研究提供了一种新的突变模式动物品系.     

三氧腰椎旁注射联合硬膜外阻滞治疗腰椎间盘突出症的疗效

目的观察比较三氧腰椎旁注射联合硬膜外阻滞及单纯硬膜外阻滞治疗腰椎间盘突出症的效果。方法腰椎间盘突出症患者60例,随机分为两组：单纯行硬膜外阻滞组（对照组）和硬膜外阻滞联合三氧组（治疗组）,各组30例。于治疗前和治疗后3、6个月时采用VAS评分评估疼痛程度,并观察治疗前后临床体征变化。结果与对照组相比,治疗组治疗结束时及3个月时VAS评分较低（P〈o．05）;6个月时,对照组优效、良效、好转、无效率依次为66．7％（20／30例）、6．7％（2／30例）、6．7％（2／30例）、20．0％（6／30例）;治疗组优效、良效、好转、无效率依次为73．3％（22／30例）、13．3％（4／30例）、6．7％（2／30例）、6．7％（2／30例）,治疗组总有效率高于对照组（P〈0．05）。结论三氧腰椎旁注射联合硬膜外阻滞治疗腰椎间盘突出症疗效优于单纯采用硬膜外阻滞。     

老年人低位硬膜外麻醉围术期自主神经功能的变化

目的：应用心率变异性（HRV）分析仪监测评估低位硬膜外麻醉围术期自主神经的改变。方法：选择低位硬膜外麻醉下择期手术患者20例,ASAⅠ-Ⅱ级,按年龄分为老年组和年轻组,每组10例,观察术前1d、麻醉完善后切皮前、切皮后30min、术后2h,1d,3d,7d处时相点的心率（HR）、平均动脉压（MAP）以及HRV分析各成分变化。结果：围术期老年组HRV显示RMSSD（相邻RR间期差值均方根）、总频（TP）、低频（LF）、代频标化（LFnorm)均呈显著性下降,同时伴有心率减慢、平均动脉下降。年轻组TP和LF在麻醉完善后切皮前、术后2h,1d下降显著,于术后3d恢复,而R和MAP在围术期无显著改变。两组两比较,老年组TP和LF在麻醉后各时相占 明显低于年轻组（P＜0．01）。老年组高频（HF）及高频标化（HFnorm)在麻醉给药后切皮瓣均无明显变化,但在术中和术后各时相点的下降,而年轻组仅切皮后30min,出现一过性下降。结论HRV可较好地评估围术期机体自神经变化;术期麻醉和手术创伤均可使机体自主神系统调节受损,尤其老年人受损程度大,恢复慢,恢复慢,术后1周仍不能完全恢复。     

The role of succinylcholine in the prevention of the obturator nerve reflex during transurethral resection of bladder tumors

OBJECTIVE: To present our 8 year experience in the prevention of the obturator nerve reflex during transurethral resection of bladder tumors. METHODS: This study was performed in Ataturk University Hospital between 1999 and 2007. We retrospectively reviewed the records of 89 patients with inferolateral bladder tumors, who underwent transurethral resection under epidural or general anesthesia and requested obturator nerve reflex inhibition. Epidural anesthesia was administered to 57 patients, while the remaining 32 patients underwent general anesthesia via mask; and succinylcholine was administered prior to resection. RESULTS: Of the 57 patients received epidural anesthesia, 18 were diagnosed as inferolateral bladder tumors during endoscopy and had to undergo general anesthesia. Obturator nerve block was attempted preoperatively in 39 patients. However, a nerve identification failure, a hematoma, and 4 obturator nerve reflex events, despite the block, were observed and these patients were subjected to general anesthesia with succinylcholine. Fifty-six patients (32 patients initially had general anesthesia and 24 converted from epidural to general anesthesia) were all given succinylcholine prior to resection. CONCLUSION: Due to its mechanism of action, succinylcholine is completely effective and represents a simple alternative to obturator nerve block. No contraction was observed in any patient given succinylcholine.     

神经刺激器辅助下腰丛联合坐骨神经阻滞与腰硬联合麻醉在膝关节镜手术麻醉的效果比较

目的比较神经刺激器辅助下腰丛联合坐骨神经阻滞与腰硬联合麻醉在膝关节镜手术的麻醉效果。方法 60例膝关节镜手术患者随机分为腰硬联合组（C组）和腰丛联合坐骨神经阻滞组（N组）两组,每组30例。C组行腰硬联合麻醉,硬膜外腔置管,腰麻药0.5%罗哌卡因重比重液3 ml,不足者酌情硬膜外腔追加0.75%罗哌卡因;N组采用神经刺激仪辅助下腰丛联合坐骨神经阻滞,局麻药为0.45%罗哌卡因,腰丛阻滞剂量25~30 ml,坐股神经阻滞剂量20~25 ml。记录并比较两组麻醉血流动力学、起效维持时间、麻醉效果、辅助用药、补液量以及不良反应。结果两组患者血流动力学比较,C组麻醉后10 min（T10）、麻醉后20 min（T20）MAP下降（P〈0.05）,T20HR下降（P〈0.05）,C组T20MAP、HR低于N组（P〈0.05）;C组麻醉准备及操作时间（Tr）、感觉完全阻滞时间（T1）、运动完全阻滞时间（T2）、感觉恢复时间（T3）、运动恢复时间（T4）低于N组（P〈0.05）,术后首次排尿时间（Tu）长于N组（P〈0.05）;N组并发症少于C组。结论神经刺激器辅助下腰丛联合坐骨神经阻滞用于膝关节镜手术麻醉,阻滞完善,麻醉效果确切,血流动力学平稳,并发症少,尤其适合相对长时间患者。     

硬膜外注入浓当归液术后镇痛的临床探讨

将35例病人随机分为3组,当归组(14例),吗啡组(10例),生理盐水对照组(11例)。术后留置硬膜外导管,待病人伤口疼痛较剧时,从三种溶液中随机取一种经硬膜外导管注入,并记录镇痛起效时间、持续时间和副作用。结果证明,当归组与吗啡组之间镇痛效果差异无显著性(P>0.05)。说明浓当归液硬膜外注射术后镇痛效果确切可靠、无毒副作用,利于伤口生长及恢复,易于推广,初步动物实验无神经损伤等优点。     

Vecuronium and fentanyl requirement in abdominal surgery under combined epidural-general anaesthesia and general anaesthesia alone

Individual effect of epidural block and general anaesthesia is well established in the field of anaesthesiology. But adequate literature is yet not available to give decisive answer regarding the requirement of muscle relaxants and opioid analgesic when the two methods are combined together. In the present study, sixty patients, aged 18-50 years of both sexes with ASA (American Society of Anesthesiologists) grading I and II scheduled to undergo for major abdominal surgery were assigned randomly into two groups (30 in each group), where Group A received general anesthesia and Group B received combined epidural-general anesthesia. The patients with combined technique, epidural catheter tip were placed between T9-10. Ten ml of 0.125% bupivacaine was administered through the epidural catheter. Peripheral nerve stimulator was used to monitor neuromuscular transmission and subsequently to administer incremental dose of neuromuscular blocking drugs. All the patients were pre-medicated with fentanyl (2μg/kg) to reduce intubation reflex. Then the patients of both groups were pre-oxygenated for 3 minute and anaesthesia was induced with thiopental sodium 3-5 mg/kg body weight. Endotrachial intubation was facilitated by vecuronium 0.1mg/kg body weight. Anaesthesia was maintained with 60% N2O in O2 and halothane (0.4 to 0.8%). Fentanyl was given in incremental dose of 0.5 μg/kg to maintain an adequate analgesia. The vecuronium was given at the dose of 0.02 mg/kg, when TOF return to 25% of the base line. The mean±SD requirement of vecuronium in general anaesthesia group was 0.0016±0.00013 mg/kg/min and whereas in combined epidural-general anaesthesia, it was 0.0011±0.00014 mg/kg/min. The requirement of fentanyl was 0.71μg/kg/hr in general anaesthetic group whereas in combined group it was 0.31μg/kg/hr. These findings prompt us to place optimal dosing guidelines so as to avoid overdosing and thus delay recovery and help to get the excellent outcome of the surgery.     

Spread of epidural blockade in the anaesthetised pig using technetium99 and sensory-evoked potentials

Our objective was to determine the extension and duration of a stable segmental thoracic or lumbar epidural blockade by lidocaine in the 20 to 25-kg pig. Fourteen anaesthetised pigs were investigated. The radioactive isotope technetium99 (Tc99) was added to lidocaine to evaluate the spread in the epidural space. One ml of this solution was administered via an epidural catheter either at the Th(6-7) or L6-S1 level. Sensory-evoked potentials (SEPs) were measured following peripheral nerve stimulation, to determine duration and sensory extension of the epidural blockade. The thoracic anatomical mean spread was 14.2 vertebrae. The end points of the spread were C3-C7 and Th8-Th13 and the lumbar anatomical mean spread was 10.2 vertebrae. The end points were Th10-Th12 and L6-S1. It was possible to abolish the SEPs with 2 and 4% lidocaine. A smaller volume of lidocaine was needed if a second dose was administered within 20 min. With 4% lidocaine it was possible to abolish the SEPs for more than 180 min. The use of 1 ml of 4% lidocaine repeated after 20 and 60 min at the Th(6-7) or L6-S1 level achieved a stable thoracic or lumbar epidural blockade.     

甲钴胺治疗非压迫性腰椎间盘突出症的实验研究

目的在无机械压迫情况下,甲钴胺对大鼠白体髓核导致的神经根损伤有无修复作用。方法选择10月龄SD雄性大鼠24只,随机分成对照组、模型组、甲钴胺治疗组,每组8只。切开大鼠尾椎椎间盘,髓核呈胶冻样,取5个髓核并加入501．d生理盐水,充分搅拌稀释成混悬液备用,将混悬液注射到大鼠硬椎硬膜外腔制作动物模型。24只SD雄性大鼠随机分成对照组、模型组和甲钴胺干预组,分别将生理盐水、尾椎髓核混悬液注射到腰椎硬膜外腔,甲钴胺治疗组用甲钴胺（500μg／kg）注射液,每天腹腔内注射共20d。测定大鼠后肢机械刺激缩爪阈值和疼痛相关行为,20d后观察神经根的组织形态学变化。结果在无机械压迫情况下,硬膜外移植自体髓核能使大鼠后肢产生明显的痛觉过敏,神经根出现脱髓鞘改变;甲钻胺可以明显减轻大鼠的痛觉过敏,促进髓鞘再生。结论甲钴胺对自体髓核致神经根的脱髓鞘损伤有修复作用。