连续腰麻与腰-硬联合麻醉用于下肢手术的临床对比研究

目的旨在通过应用连续腰麻（CSA）和腰-硬联合麻醉（CESA）行下肢手术的对比，探讨CSA的临床麻醉效果、术后并发症等情况。方法收集拟行骨科下肢手术的患者70例，随机分为CSA组和CESA组，各35例。两组患者均选择L弼或L3-4椎间隙穿刺，成功后CSA组向蛛网膜下腔置人Spinocath管1～2cm并注入0．5％左旋布比卡因1．2mL，CESA组通过腰-硬联合麻醉针的内针向蛛网膜下腔注入0．5％左旋布比卡网2mL．然后向头端硬膜外腔置管3-4cm。观察并记录两组患者麻醉前和麻醉后血压及心率的变化、感觉及运动阻滞参数、Bromage评分、加用辅助药、不良反应及术后并发症等情况。结果两组平均动脉压麻醉后最低值与术前相比显著下降（P〈0．05），且CESA组较CSA组平均动脉压下降明显（P〈0．05）；两组感觉和运动阻滞参数、麻醉效果评定及Bromage评分比较，差异无统计学意义（P〉0．05）；CESA组不良反应及辅助药用量明显多于CSA组（P〈0．05）。结论连续腰麻应用于下肢手术具有麻醉效果佳、血流动力学稳定、可控性强及不良反应少等优点，尤其适用于中老年患者的下肢手术。

Clinical comparative study of continuous spinal anesthesia and combined epidural-spinal anesthesia used for lower limb surgery

Objective To explore the clinical anesthetic effect, postoperative complications of continuous spinal anesthesia, through the continuous spinal anesthesia （CSA） and combined epidural-spinal anesthesia （CESA） used for lower limb surgery. Methods 70 patients who underwent lower limb surgery were collected and randomly divided into CSA group and CESA group, with 35 cases in each group. Both groups were punctured at L2-3 or L3-4 vertebral gap, after the success of the CSA group, spinocath tube were placed 1-2 cm to subarachnoid and then injected 0.5% Levobupivacaine 1.2 mL, for the CESA group injected 0.5% Levobupivacaine 2 mL through the needle who within the needle of combined epidural-spinal anesthesia, then placed a catheter 3-4 cm to the head-end epidural through the needle. The changes of blood pressure and heart rate parameters, sensory and motor block parameters, the Bromage score, plus the adjuvant drugs, adverse reactions and complications of patients before anesthesia and ＇after anesthesia between the two groups were observed and recorded. Results Between two groups, the minimum value of mean arterial pressure after anesthesia was significantly decreased than preoperative （P 〈 0.05）, anti CESA group was significantly decreased than CSA group in mean arterial pressure （P 〈 0.05）, sensory and motor block parameters and anesthetic： effect assessment of contrast and the Bromage score were nut signifi- cantly different （P 〉 0.05）; the adverse reac.tions aml auxiliary medicine dosage in CESA group were significantly more than those in CSA group （P 〈 0.05）. Conclusion Continuous spinal anesthesia applied in lower limb operation has good effects of anesthesia, hemodynamie stability, strong controllability and less adverse reactions, etc, especially for ehlerly patients with lower limb operation.