硬膜外预充液对腰硬联合阻滞剖宫产术患者硬膜外置管血管损伤及腰麻效果的影响

目的 观察硬膜外预充液预防剖宫产术患者硬膜外导管致硬膜外血管损伤及腰麻效果的影响.方法 将180例单胎足月妊娠拟在腰硬联合麻醉下行剖宫产术的产妇,按随机数字表法分为3组,每组60例.3组产妇均取左侧卧位,L2-3椎间隙行腰硬联合穿刺.硬膜外穿刺成功后将脊麻针穿过硬膜外针内腔行蛛网膜下隙穿刺,见脑脊液回流后,注入0.75％左布比卡因2.0 mL,拔出腰麻针.Ⅰ组产妇硬膜外置管前在硬膜外腔注入生理盐水5 mL;Ⅱ组产妇硬膜外置管前在硬膜外腔注入含麻黄素15 mg的生理盐水5 mL;Ⅲ组产妇硬膜外腔直接置入导管.记录3组产妇血管损伤发生率,观察麻醉注药前(T0),经穿刺针注药液后2 min(T1),5 min(T2)HR、SBP、DBP的变化,以及采用针刺法测定注药后5、10 min时的感觉阻滞平面.结果 Ⅰ、Ⅱ、Ⅲ组血管损伤发生率分别为3.3％、1.6％及13.3％,Ⅲ组血管损伤发生率明显高于Ⅰ组和Ⅱ组(均P＜0.05),Ⅰ组和Ⅱ组比较差异无统计学意义(P＞0.05).3组产妇T1及T2的SBP较T0有明显的下降(均P＜0.05),3组间比较差异均无统计学意义(均P＞0.05).Ⅰ、Ⅱ组感觉阻滞平面较Ⅲ组明显升高(P＜0.05),Ⅰ、Ⅱ组注药后感觉阻滞平面比较差异无统计学意义(P＞0.05).结论 腰硬联合麻醉剖宫产产妇在硬膜外预充少许液体,可以预防硬膜外导管置入时损伤血管,提高剖宫产产妇腰硬联合阻滞麻醉的安全性,同时还可改善腰麻的效果.

Effects of Fluid Preloading before Epidural Analgesia Combined with Lumbar Epidural Block for Cesarean Section on Epidural Catheterization-induced Vascular Injury and Lumbar Anesthesia Efficacy

Objective To observe the effects of fluid preloading before epidural analgesia combined with lumbar epidural block for cesarean section on epidural catheterization-induced vascular injury and lumbar anesthesia efficacy.Methods One hundred and eighty parturients with single fetus full-term pregnancy who were scheduled for cesarean section under combined spinal-epidural anesthesia were randomly divided into three groups,with 60 parturients in each group.Lumbar epidural puncture was performed at L2-3 lumbar interspace in all parturients in the left lateral position.Spinal needle was inserted through the lumen of the epidural needle for subarachnoid puncture and 0.75% levobupivacaine（2 mL）was injected after backflow of cerebrospinal fluid.Then,spinal needle was removed.GroupⅡwas given epidural injection of 5 mL normal saline containing 15 mg ephedrine before epidural catheterization.GroupⅢ was directly given epidural catheterization.The incidence of vascular injury was recorded in the three groups.The changes in heart rate（HR）,systolic blood pressure（SBP） and diastolic blood pressure（DBP） were observed before injection（T0）and 2（T1）and 5 minutes（T2） after injection.Sensory block level was measured by a pinprick test at 5 and 10 minutes.Results The incidence of vascular injury in group Ⅲ（13.3%）was significantly higher than that in group Ⅰ（3.3%）or group Ⅱ（1.6%）（all P0.05）,but no obvious difference was found between group Ⅰ and group Ⅱ（P0.05）.The SBP levels at T0 were significantly lower than those at T1 or T2（all P0.05）,but there were no obvious differences among the three groups（P0.05）.Compared with group Ⅲ,sensory block level significantly increased in group Ⅰ and group Ⅱ（all P0.05）,but no obvious difference was found between the two groups（P0.05）.Conclusion Fluid preloading before epidural analgesia combined with lumbar epidural block for cesarean section can prevent epidural catheterization-induced vascular injury,increase the security of lumbar epidural anesthesia,and improve the efficacy of lumbar anesthesia.