钢丝加强聚脲胺酯硬膜外导管减少硬膜外出血发生率

目的 比较钢丝加强聚脲胺酯与聚氯乙烯硬膜外导管对硬膜外腔出血发生率的影响. 方法 150例拟行连续硬膜外或蛛网膜下腔-硬膜外联合阻滞患者,按随机数字表法分为聚氯乙烯硬膜外导管组(A组,n=75)和钢丝加强聚脲胺酯硬膜外导管组(B组,n=75),以阻力消失作为判断硬膜外针到达硬膜外腔的标志,记录放置硬膜外导管遇到阻力和同抽出血情况.追踪术后1周有无硬膜外血肿发生. 结果两组间性别、年龄、体重等差异无统计学意义(P>0.05). A组和B组未遇到明显阻力分别为42.7%和78.6%,遇到轻微阻力分别为48.0%和16.0%;遇到阻力较大,放入导管困难分别为9.3%和5.4%,组间比较差异有统计学意义(P<0.01).A组无回血为82.6%,有不连续回血率为10.7%,有连续回血率为6.7%;B组无回血率为100%,组间比较差异有统计学意义(P<0.01).两组术后均无硬膜外血肿压迫症状的并发症.结论 聚氯乙烯硬膜外导管损伤硬膜外血管引起出血为常见并发症,采用钢丝加强聚脲胺酯硬膜外导管可显著减少硬膜外出血发生率.

Wire polyurethane epidural tube can decrease the incidence of epidural bleeding

Objective To compare the influence of wire polyurethane epidural tube and polyvinyl chloride epidural tube on the incidence of epidural bleeding. Methods 150 patients undergoing continues epidural anesthesia(EA) or combined epidural and spinal anesthesia (CSEA) were randomized into wire polyurethane epidural tube group (group A, n=75) and polyvinyl chloride tube group (group B, n=75). The epidural space was determined by loss of resistance. The resistance to insertion of epidural tube and withdrawing bleeding from epidural tube were recorded. Postoperatively, epidural hematoma was tracked for 1 week. Results The sex, age, weight and ratio of EA and CSEA were comparable between groups(P>0.05) . No resistance to insertion of epidural tube occurred in 42.7% and 78.6% of patients. Mild resistance to insertion of epidural tube was encountered 48.0% and 16.0% of patients, and difficulty to insertion of epidural tube was found in 9.3% and 5.4% of patients in groups A and B, respectively. They all were significantly different (P<0.01).In group A, no blood was withdrawn from epidural tube in 82.6% of patients, un-continuous blood was withdrawn in 10.7% of patients and continuous blood was withdrawn in 6.7% of patients. In goup B, no blood was withdrawn from epidural tube in 100% of patients.Incidence of no withdrawing bleeding from epidural tube was significantly higher in group B than in group A (P<0.01). NO epidural hematoma occurred in both group 1 week after surgery. Conclusion Bleeding due to epidural blood vessels injuried by insertion of polyvinyl chloride tube is common complication, whereas the use of wire polyurethane epidural tube can markedly reduce this complication.