硬脊膜穿破重新穿刺行硬膜外术后镇痛的临床观察

目的评估在硬膜外穿刺或置管中并发硬脊膜穿破改间隙重新穿刺置管行术后镇痛的安全性及观察头痛的发生率。方法63例ASAI-II级下腹部和下肢手术患者,其中42例为硬膜外穿刺或置管中并发硬脊膜穿破者,在改向上一个间隙重新穿刺置管后,术毕随机将21例行硬膜外术后自控镇痛(PCEA)作为观察组,另21例未行PCEA的作为对照组。以硬膜外穿刺一次性成功行PCEA的21例作为常规组。术后对病人进行48hBP、HR、RR及SpO2的监测,并观察镇痛效果和头痛的发生情况。结果所有病人均在硬膜外麻醉下顺利实施手术。行PCEA病人均获得满意镇痛效果。观察组与常规组镇痛期间未见呼吸抑制,48h镇痛用药量组间比较无显著性差异。头痛发生率观察组为19%(4/21),对照组为57%(12/21),前者明显少于后者(P<0.01),且头痛持续的时间也较短、症状轻。结论硬脊膜穿破改向上一个间隙重新穿刺置管在术后加强监测同时行PCEA是安全可行的,且具有防治头痛及缓解的症状和缩短头痛持续时间的疗效。

Clinical Observations of the Analgesic Effect of Epidural Resiting Following Accidental Dural Puncture

Objective To evaluate the safety of epidural resiting and the incidence of postdural puncture headache following accidental dural puncture. HZ Methods Among 63 patients of ASA I-II undergoing lower abdominal or lower extremity surgery, forty-two with postdural puncture who had received epidural resiting were randomly assigned to patient controlled epidural analgesia (PCEA) ( n =21) or control treatment ( n =21). The remaining 21 patients who had successful epidural insertion received the routine PCEA. All patients after operation received 48-hours monitoring of BP, HR, RR and SpO_2. The analgesic effect of each treatment and the occurrence of headache were also assessed. Results All operations were uneventful under epidural anesthesia. A satisfactory level of analgesia was observed in patients who received PCEA. There was no statistically significant difference in pain control between patients who had had epidural resiting and who received PCEA and those who received routine PCEA. No respiratory inhibition was observed. The occurrence of headache in the epidural resiting group was 19% (4/21), compared to 57% (12/21) in the control group ( P <0.01). Theheadache was generally mild and short in duration. Conclusion Epidural resiting following accidental dural puncture is effective for reducing postoperative headache and safe if the vital signs are monitored.