硬膜外预充生理盐水对置管诱发剖宫产术患者硬膜外血管损伤的影响

目的 评价硬膜外预充生理盐水对置管诱发剖宫产术患者硬膜外血管损伤的影响.方法 单胎足月妊娠拟在硬膜外麻醉下行子宫下段剖宫产术的患者150例,ASA分级Ⅰ或Ⅱ级,年龄27～33岁,体重66～75 kg.随机分为3组(n=50),Ⅰ组直接置入硬膜外导管,Ⅱ组和Ⅲ组在硬膜外置管前通过硬膜外针注射0.9%生理盐水或含肾上腺素(1:200 000)的生理盐水5 ml,注射完后保持注射器压缩针栓20 s,使液体充分扩散.记录置入硬膜外导管时硬膜外穿刺针针尾见淡红色血水、硬膜外导管回抽见淡红色血水、硬膜外导管置入血管(从导管回抽出新鲜血液)的发生情况.结果 与Ⅰ组比较,Ⅱ组和Ⅲ组硬膜外穿刺针针尾见淡红色血水的发生率、硬膜外导管回抽见淡红色血水的发生率和硬膜外导管置入血管的发生率均明显降低(P＜0.01);Ⅱ组和Ⅲ组间上述指标差异无统计学意义(P＞0.05).结论硬膜外预充生理盐水5 ml可有效预防置管诱发剖宫产术患者硬膜外血管的损伤.1∶200 000肾上腺素并不能进一步预防置管诱发的硬膜外血管损伤.

Effect of preloading epidural space with normal saline on the incidence of injury to blood vessel by epidural catheter placement for cesarean section

Objective To evaluate the effect of preloading the epidural space with normal saline (NS) on the incidence of injury to blood vessel by epidural catheter placement for cesarean section. Methods One hundred and fifty parturients with a single baby at full term in vertex presentation scheduled for cesarean section under continuous epidural anesthesia were randomly divided into 3 groups ( n = 50 each): Ⅰ group control; Ⅱ group NS needle attached to a 5 ml syringe. Loss of resistance was used to identify the epidural space. In group Ⅰ no fluid was injected into the epidural space before insertion of catheter; while in group Ⅱ and Ⅲ NS 5 ml with or without whom blood or blood tinted fluid was withdrawn from epidural catheter was recorded. Results The number of patients in whom blood or blood tinted fluid was withdrawn from epidural catheter was significantly lower in group Ⅱand Ⅲ than in group Ⅰ but was not significantly different between group Ⅱ and Ⅲ. Conclusion Preloading the epidural space with 5 ml NS can reduce the incidence of injury to blood vessel induced by insertion of epidural