硬膜外麻醉首次尾端注药及肾上腺素应用的临床研究

目的 :观察硬膜外麻醉首次尾端注药及肾上腺素的应用效果。方法 :选择期下腹部手术病人 5 9例 ,随机分为三组 ,Ⅰ组用 2 %盐酸利多卡因。Ⅱ组为首次尾端注药组 ,2 %盐酸利多卡因 15ml+ 5 %碳酸氢钠 5ml。Ⅲ组为首次尾端注药 +肾上腺素组 ,2 %盐酸利多卡因 15ml+ 5 %碳酸氢钠 5ml + 1∶2 0肾上腺素。分别于穿刺成功后注药 ,观察心率 (HR)、血氧饱和度(SPO2 )、无创血压 (SBp、DBp、MAP)及麻醉起效时间、阻滞完善时间、麻醉持续时间、阻滞平面的变化。结果 :第Ⅱ、Ⅲ组与第Ⅰ组比较 ,麻醉效果好 ,腹腔脏器牵拉痛减轻 (P <0 0 1)。第Ⅲ组与第Ⅰ、Ⅱ组比较 ,心率 (HR)、血压 (SBp、DBp)比较稳定 (P <0 0 5 ) ,麻醉持续时间延长 (P <0 0 5 )。结论 :硬膜外麻醉首次尾端注药可使麻醉平面增宽 ,阻滞完善 ,减少内脏牵拉刺激。加入肾上腺素可延长麻醉作用时间 ,减少血液动力学的改变。

The clinical study of initial drug injection to end part by peridural anesthesia and adrenalin application

Objective To observe the application effect of the initial drug injection to end part by peridural anesthesia and adrenalin.Method Choosing 59 cases of lower abdomen operation patients and allocated them into three groups(Ⅰ?Ⅱ?Ⅲ)randomly.Ⅰ with 2% lidocaine hydrochloride,Ⅱ with drug injection to end part initial,2% lidocaine hydrochloride 15ml+5% NaHCO 3 5ml.Ⅲ with drug injection to end part initial+adrenalin,2% lidocaine hydrochloride 15ml+5% NaHCO 3 5ml+1∶20 adrenalin.Drug was injected specially after spunction success.Observe HR?SpO 2?SBp?DBp?MAPand anesthesia starting time,block completing time,anesthesia lasting time,block flate change.Results Ⅱ?Ⅲ anesthesia effect is much better than Ⅰ,and decrease the abdomen organ reffered pain( P <0 01).The stabalizatin of HR?SBP?DBP in group Ⅱ is better than Ⅰ?Ⅱ( P <0 05)and prolong anesthesia lasting time( P <0 05).Conclusion The initial drug injection to end part by peridrual anesthesia can make anesthesia plate wider,blocking completer and decreasing reffered pain of adomen organ.The addication of adrenalin can prolongate the anesthesia action time,decrease the hemodynamic change.