负压气囊在椎管内联合麻醉穿刺中的应用

蛛网膜下腔－硬膜外联合麻醉（ＣＳＥＡ）是将腰麻和硬膜外麻醉结合在一起的新方法,目前此种联合麻醉多采用Ｇ２５－２７针内针型腰穿针,由于该针细长脑脊液回流缓慢不易观察,因而我们采用自制负压气囊,以助观察脑脊液回流,判断腰穿是否成功,效果满意,现报告如下：负压气囊制作与应用方法将Ｍａｌｌｉｎｃｋｏｒｄｔ气管导管上充气套囊连接气管导管端剪去２ｍｍ再接上内径２．５ｍｍ、长１６ｍｍ的玻璃管,其充气囊另一端带有充气阀,见图１。我们采用的是ＣＳＥＡ针内针型２５Ｇ腰穿针,于Ｌ３－４行硬膜外穿刺成功后拔出针芯,自硬…     

椎管内联合穿刺麻醉的临床应用

我们用１８ＧＴｕｏｈｙ针（勺状背部打孔）与７Ｇ腰穿针配套使用，一次穿刺完成脊麻（ＳＡ）和硬膜外阻滞（ＥＡ）的操作及其复合麻醉（ＣＳＥ），用于脐部以下手术１１６例。对ＣＳＥ的器械性能、实施、麻醉效果及副作用进行了临床观察。资料和方法本组共１１６例，男１２例，女１０４例。年龄１３～６８岁，体重４５～８８ｋｇ，身高１４８～１７８ｃｍ。ＡＳＡⅠ～Ⅱ级。手术种类：外科２１例，妇科４０例，产科４９例，骨科６例。以２０例ＣＳＥ的子宫全切术患者为观察组，另选４０例ＥＡ的同类手术患者随机分为两个对照组。三组年龄、…     

椎管内麻醉不同穿刺入路对膝关节镜手术的影响

目的：观察直入穿刺法与旁入穿刺法2种不同椎管内麻醉穿刺方法对膝关节镜手术患者的影响。方法：择期行膝关节镜手术120例,ASA Ⅰ～Ⅱ级,按随机数字表法随机分为直入法穿刺组和旁入法穿刺组。均采用一点法即针内针单间隙穿刺技术。观察每组患者的麻醉起效时间、穿刺成功率、神经异感、硬膜外置管困难发生率、硬膜外导管误入血管发生率、术后腰背痛发生情况,麻醉后1、5、10、30min无创血压、心率、脉搏血氧饱和度。结果：直法与旁入法腰麻硬膜外联合穿刺在麻醉起效时间（5．24±0．4）min vs（5．14±0．6）min、硬膜外置管困难发生率1．7％ vs 1．7％、硬膜外导管误入血管发生率3．4％ vs 1．7％、神经异感发生率3．4％ vs 3．4％无显著性差异（P〉0．05）。麻醉后1、5、10、30min SBP、DBP、HR、SpO2,2组间差异无统计学意义（P〉0．05）。旁入法术后腰背痛的发生率75．0％（45／60） vs 23．3％（14／60）及持续时间（2．44±0．8）d vs（2．04±0．7）d明显低于直入法组（x^2=32．042,P=0．000;t=2．195,P=0．004）。结论：2种麻醉穿刺方法均可安全有效地应用于膝关节镜手术;与直入法相比,旁入法腰麻硬膜外联合麻醉术后腰痛发生率低。     

椎管内联合穿刺的临床应用

临床上,有些下腹部手术,尤其盆腔手术要求麻醉时间较长,肌肉完全松弛,而单纯腰麻或硬膜外麻醉难以完全满足其手术要求。近年来,我们采用联合腰麻硬膜外麻醉(CSEA)应用于腹部以下手术,并观察其临床效果及并发症。现报道如下。资料与方法一般资料　选择ASA～级择期手术病人100例,     

椎管内分娩镇痛进展

分娩镇痛一直是人类所关心的重要课题,但至今尚无一种满意而安全的分娩镇痛方法。近几年随着脊髓吗啡镇痛机制研究的深入和分娩镇痛新药、新技术的临床应用,减少了以前分娩镇痛中对产妇、胎儿及产力的不良影响,分娩镇痛逐步完善。本文对目前椎管内分娩镇痛的进展作一概述。脊髓阿片肽及受体系统在分娩镇痛中的调节机制目前已公认,人体的阿片肽及受体至少有三大体系:脑啡肽/μ受体、内啡肽/σ受体和强啡肽/κ受体体系。目前已发现μ2、σ1和κ1受体存在于脊髓中并参与镇痛调节。Ｄａｗｓｏｎ和Ｇｉｎｔｚｌｅｒ[1,2]通过全身或脊髓蛛网膜下腔…     

异丙酚辅助小儿椎管内麻醉和观察

小儿于骶管或硬膜外麻醉下施行手术时 ,由于难以合作 ,常需辅助氯胺酮静注或静滴 ,但氯胺酮麻醉后恶心呕吐等副作用发生率高。异丙酚是一种诱导快、苏醒快、镇静好、无蓄积的静脉麻醉药 ,小儿麻醉后呕吐发生率低。因此 ,用异丙酚代替氯胺酮作为小儿椎管内麻醉的辅助药 ,具有一定优点。本文观察低负荷量异丙酚后 3种维持量下循环、呼吸变化、镇静深度、停药后清醒时间及副作用。资料与方法45例择期行疝囊结扎修补、尿道下裂成形、直肠阴道修补、隐睾还纳及骨盆截骨、骨折切开复位术的ＡＳＡⅠ～Ⅱ级患儿 ,年龄 2 5～ 10岁 ,体重 13～ 30ｋｇ…     

椎管内麻醉后麻醉平面客观指标的临床研究

目的利用热成像技术，对比20例临床择期下肢手术麻醉前后的皮肤温度变化，探讨以皮肤表面温度变化作为确定麻醉区域客观指标的临床意义。方法随机选取20例择期下肢手术病人，分别观察麻醉区域内同一点麻醉施行前后的皮肤表面温度及红外线扫描图像的变化。结果麻醉区域内麻醉施行后皮肤表面温度显著升高，红外线图像有明显变化，可将皮肤温度作为确定麻醉区域的客观指标。结论基于人体细胞新陈代谢产生热量不一，利用红外线热成像技术，对麻醉平面提供定性依据。     

椎管内麻醉的有关问题

将局麻药注入到椎管内的不同间隙，药物作用于脊神经根，暂时阻滞脊神经的传导，使其所支配的相应区域产生麻醉作用，称为椎管内麻醉。椎管内麻醉包括蛛网膜下隙阻滞（又称脊麻或腰麻）和硬膜外隙阻滞（又称硬膜外麻醉）。椎管内阻滞是麻醉医生必须掌握的基本技能。     

小儿蛛网膜下腔阻滞的临床研究进展

小儿蛛网膜下腔阻滞(腰麻)在20世纪初首次引入临床,因能降低与全麻相关的发病率和死亡率,而被广泛应用于小儿腹部以下手术。近年来,凭借较小的循环呼吸功能干扰和围术期麻醉监测技术的发展,小儿腰麻再次受到关注,相关研究日益增多。本文着重围绕小儿腰麻的优势、局麻药物用法、辅助用药、超声在小儿腰麻中的应用、现存问题等五个方面进行综述,通过总结国内外应用现状,探讨其在小儿部分手术中的优势,以期为小儿腰麻的临床实践提供参考。     

The efficacy of preoperative pregabalin on reduction of the incidence and severity of postdural puncture headache after spinal anesthesia

ObjectiveThe aim of this study was to evaluate the efficacy of prophylactic pregabalin on postdural puncture headache incidence and severity after spinal anesthesia.Method86 ASA I-II male and female patients age 20–50 years old, undergoing elective general surgeries below the umbilicus under spinal anesthesia with 3 ml heavy bupivacaine 0.5% (15 mg), patients were randomly allocated into one of two groups (Group C, n = 43) (control group) received a placebo capsule 2 h preoperatively (Group P, n = 43) received 150 mg pregabalin capsule 2 h preoperatively, number of attempts for spinal block, sensory level, motor block grade, postoperative time to first analgesic requirement, the incidence, onset and intensity of PDPH and adverse events were recorded for 72 h.ResultsThe peak sensory level in C group and P group showed no statistical significant difference, the time to peak sensory block was significantly earlier in P group than group C, the time to reach the modified Bromage motor block grade 3 was significantly earlier in P group than C group, time to two segment regression of sensory level to S1 and motor block regression to modified Bromage grade 0 were statistically insignificant between the studied groups. Group P had a significantly longer time to first analgesic requirements than group C, and there was no significant difference in VAS (visual analogue scale) of pain between the studied groups. There was significant increase in sedation score in P group compared to C group at 2 h and 6 h postoperatively, and there was statistically significant reduction in the incidence rate and severity of PDPH in P group compared to group C. There were no recorded cases of dizziness, visual disturbances, or PONV.Conclusionspreoperative oral pregabalin 150 mg reduced the incidence and severity of PDPH, beside the earlier onset of peak sensory and motor block with increase duration of analgesia in patients undergoing elective surgeries under spinal anesthesia.     

小剂量布比卡因-芬太尼腰麻行全子宫切除术

目的　探讨鞘内阿片类药物与小剂量局部麻醉药联合应用是否可获得满意的腰麻效果。方法　 32例行全子宫切除术的病人随机分为A、B两组 ,每组 16例。A组腰麻用药为布比卡因5mg与芬太尼 2 0 μg ;B组布比卡因 10mg。收缩压小于 90mmHg或平均动脉压较基础水平下降 2 5 %定义为低血压。低血压用麻黄碱 5～ 10mg静注 ,最大剂量 5 0mg ,或去氧肾上腺素 10 0～ 2 0 0 μg静滴。结果　所有病人均获得满意的麻醉效果。A组有 1例使用麻黄碱 10mg。B组有 14例使用血管加压药物维持血压 ,麻黄碱平均使用量 35mg ,有 3例使用去氧肾上腺素。A组收缩压、舒张压、平均动脉压最低时分别下降到 (10 6± 2 2 )、(6 7± 16 )、(81± 13)mmHg ,而B组为 (86± 2 3)、(5 8± 14)、(6 8± 16 )mmHg ,差异显著。结论　小剂量布比卡因 5mg与 2 0 μg芬太尼联合使用行腰麻即可实施全子宫切除术。与 10mg布比卡因相比 ,小剂量联合用药较少引起低血压     

罗比卡因和布比卡因在老年人脊麻中的应用

目的比较罗比卡因和布比卡因在老年人脊麻中的应用。方法90例老年患者在脊麻下行择期经尿道前列腺电切术(TURP)或膀胱肿瘤电切术(TURBt)。按所用局麻药随机分为三组,每组30例。Ⅰ组用布比卡因12mg,Ⅱ组用罗比卡因12mg,Ⅲ组用罗比卡因15mg。观察感觉阻滞平面、运动阻滞程度、阻滞持续时间、麻醉效果及不良反应。结果Ⅱ组运动阻滞程度和感觉、运动阻滞持续时间明显低于其他两组(P<0.05),麻醉效果差于其他两组(P<0.05)。结论罗比卡因15mg与布比卡因12mg脊麻用于老年人TURP或TURBt,可达到比较安全而完善的麻醉效果。     

不同穿刺体位在腰-硬联合麻醉剖宫产术中的比较

目的比较不同穿刺体位在腰-硬联合麻醉(CSEA)剖宫产术中的效果。方法拟行剖宫产术的足月妊娠产妇90例,随机分为两组,每组45例。选择L3~4椎间隙作为穿刺点。R组右侧穿刺腰麻后保持穿刺体位2 min后左倾30°仰卧至手术开始,L组左侧穿刺腰麻后仰卧位,并调整手术床左倾30°直至手术开始。腰麻药物均为1.0%罗哌卡因1.5 ml+10%葡萄糖0.5 ml。观察腰麻药物注入后15 min内产妇感觉阻滞效应及不良反应情况,记录新生儿Apgar评分,检测脐动脉血p H值。结果 R组产妇最终阻滞平面明显低于L组,达到最终阻滞平面所需时间明显短于L组(P0.05)。R组麻黄碱用量为0(0~6)mg,明显低于L组的6(0~12)mg(P0.05)。R组脐动脉血p H值明显高于L组(P0.05)。两组新生儿Apgar评分差异无统计学意义。结论剖宫产术采用右侧卧位穿刺注药后保持穿刺体位2 min后30°仰卧,其麻醉效果优于左侧卧位穿刺后30°仰卧体位。     

Laparoscopic surgery using spinal anesthesia.

BACKGROUND: Laparoscopic abdominal surgery is conventionally done under general anesthesia. Spinal anesthesia is usually preferred in patients where general anesthesia is contraindicated. We present our experience using spinal anesthesia as the first choice for laparoscopic surgery for over 11 years with the contention that it is a good alterative to anesthesia. METHODS: Spinal anesthesia was used in 4645 patients over the last 11 years. Laparoscopic cholecystectomy was performed in 2992, and the remaining patients underwent other laparoscopic surgeries. There was no modification in the technique, and the intraabdominal pressure was kept at 8mm Hg to 10mm Hg. Sedation was given if required, and conversion to general anesthesia was done in patients not responding to sedation or with failure of spinal anesthesia. Results were compared with those of 421 patients undergoing laparoscopic surgery while under general anesthesia. RESULTS: Twenty-four (0.01%) patients required conversion to general anesthesia. Hypotension requiring support was recorded in 846 (18.21%) patients, and 571(12.29%) experienced neck or shoulder pain, or both. Postoperatively, 2.09% (97) of patients had vomiting compared to 29.22% (123 patients) of patients who were administered general anesthesia. Injectable diclofenac was required in 35.59% (1672) for abdominal pain within 2 hours postoperatively, and oral analgesic was required in 2936 (63.21%) patients within the first 24 hours. However, 90.02% of patients operated on while under general anesthesia required injectable analgesics in the immediate postoperative period. Postural headache persisting for an average of 2.6 days was seen in 255 (5.4%) patients postoperatively. Average time to discharge was 2.3 days. Karnofsky Performance Status Scale showed a 98.6% satisfaction level in patients. CONCLUSIONS: Laparoscopic surgery done with the patient under spinal anesthesia has several advantages over laparoscopic surgery done with the patient under general anesthesia.     

氯普鲁卡因腰麻或腰-硬联合麻醉的临床研究

目的 探讨国产氯普鲁卡因用于腰麻或腰一硬联合麻醉的效果和安全性.方法 回顾性分析10 000例下腹部以下手术患者采用国产氯普鲁卡因冻干粉(生理盐水稀释成2.5%或3%溶液)腰麻或腰-硬联合麻醉.结果 腰麻平均起效时间24 s,平面固定时间7.7 min.最高阻滞平面平均为T_5.下肢运动阻滞3级者超过94%.腰麻效果平均满意率99.8%,硬膜外辅助麻醉后满意率提高到99.9%.单次腰麻完全消失平均72 min.产科患者腰麻后低血压和恶性呕吐发生率较高(分别为34%和43%).未见明显神经系统并发症和其他不良反应.结论 国产氯普鲁卡因冻干粉溶解后用于腰麻或腰一硬联合麻醉安全、有效.     

Influence of spinal anesthesia on corrected QT interval

BACKGROUND AND OBJECTIVES: Prolongation of the QT interval may result in grave cardiac arrhythmias, polymorphic ventricular tachycardia ("torsades de pointes"), and ventricular fibrillation. We assessed the influence of spinal anesthesia on the QTc interval and the potential arrhythmogenicity of this method of anesthesia. METHODS: Assessment was performed in 20 male unpremedicated patients, I or II American Society of Anesthesiologists physical status, who underwent spinal anesthesia for elective surgical procedures. Values of the QTc interval, heart rate, and arterial pressure were measured before spinal anesthesia as well as after 1, 3, 5, and 15 minutes of adequate blockade. RESULTS: Statistically significant lengthening of the QTc interval (compared with initial values) was observed in the first minute after blockade and in subsequent measurements. No differences were observed between mean values of the QTc interval after the onset of blockade. No significant changes in heart rate were noted. From the third minute on, significant decreases of the systolic, diastolic, and mean arterial blood pressure were observed as compared with baseline. These decreases in systolic, diastolic, and mean arterial blood pressure persisted for the entire study duration. No one patient developed clinically important cardiac arrhythmias. CONCLUSIONS: Spinal anesthesia provokes significant QTc interval prolongation in patients without cardiovascular disorders.     

An attack of bronchial asthma during spinal anesthesia

Key words  bronchial asthma - spinal anesthesia     

不同镇痛方法用于髋部或股骨干骨折患者椎管内麻醉摆放体位时镇痛效果的网状Meta分析

目的 采用网状Meta分析系统评价不同镇痛方法用于髋部或股骨干骨折患者椎管内麻醉摆放体位时的镇痛效果。
方法 计算机检索PubMed、Cochrane Library、Web of Science、EMbase、中国生物医学文献数据库(CBM)、中国知网、维普、万方，检索时间为建库至2022年8月，纳入髋部或股骨干骨折患者摆放体位和椎管内麻醉时实施镇痛的随机对照研究。由两名研究员独立进行文献筛选、资料提取和偏倚风险评价，采用Stata 17.0和RevMan 5.3软件进行统计分析。
结果 共纳入28篇文献，患者1 773例。累计排序概率曲线下面积（SUCRA）显示，降低摆放体位时VAS疼痛评分PENG阻滞（94.4%）效果最佳，其次是FIB联合IVA（83.8%）和FIB（71.1%）；降低椎管内麻醉时VAS疼痛评分PENG阻滞（98.2%）效果最佳，其次是FIB（71.1%）和FNB（55.6%）；缩短椎管内麻醉操作时间PENG阻滞（84.1%）效果最佳，其次是FNB（70.7%）和FIB（68.5%）；升高体位摆放质量评分PENG阻滞（99.1%）效果最佳，其次是FIB（73.1%）和FNB（52.9%）。
结论 神经阻滞或神经阻滞联合IVA可降低髋部或股骨干骨折患者体位摆放和椎管内麻醉时VAS疼痛评分、缩短麻醉操作时间和升高体位摆放质量评分。PENG阻滞对髋部或股骨干骨折患者摆放体位和椎管内麻醉时实施镇痛的效果最佳。