脑脊液流速对腰麻和硬脊膜外联合麻醉效果的影响

  目的 探讨腰麻和硬脊膜外联合麻醉中不同脑脊液流速对麻醉效果的影响。 方法 选择医院 2017-01至2018-01膝关节交叉韧带损伤需实施关节镜下韧带重建术的200例患者,分为A、B组,每组100例。A组脑脊液流速5 s以下,B组脑脊液流速10 s以上,A、B两组均选择腰麻和硬脊膜外联合麻醉, 蛛网膜下腔均给予0.5%罗哌卡因3 ml,且推注速度均为0.1 ml/s,观察并记录两组患者麻醉效果及不良反应的发生情况。 结果 A、B两组T₈阻滞出现时间分别为(9.16±0.41)min和(11.97±0.44)min;镇痛最高平面出现时间为(11.12±0.23)min和(15.24±0.22)min,A组均早于B组,差异有统计学意义(P<0.05);两组运动阻滞平面Bromage 评分比较差异无统计学意义; A组患者止血带效果为优者占99%,仅1例效果为良,明显好于B组(优87%,良12%),差异有统计学意义(P<0.05)。 结论 脑脊液流速对麻醉平面和麻醉效果产生明显影响,脑脊液流速在5 s以下,以速度为0.1ml/s的0.5%罗哌卡因推注可获得满意的麻醉效果。

Influence of different cerebrospinal fluid flow rates on the effectiveness of combined spinal-epidural anesthesia

Objective To explore the influence of different cerebrospinal fluid flow rates on the effectiveness of combined spinal-epidural anesthesia.Methods Two hundred patients undergoing anterior cruciate ligaments (ACL) of knee joint reconstruction with arthroscopy were selected and randomly divided into two groups: group A in which the cerebrospinal fluid flow rate of patients was less than 5 s (n=100) and group B in which the flow rate was above 10 s (n=100). Both groups received combined spinal-epidural anesthesia with 0.5% ropivacain 3 ml, which was diluted with 0.9% normal saline 1 ml.The injection speed was 0.1 ml/s in both groups. Anesthesia was maintained with epidural administration with 2% lidocaine if necessary during operation.Results In group A, the onset of pain block to T8 was earlier than in group B, which was(9.16±0.41) vs (11.97±0.44)min (P<0.05), while the onset time of the highest analgesia plane was(11.12±0.23)vs(15.24±0.22)min (P<0.05).There was no statistically significant difference between the two groups according to the Bromage score for motor block. The effect of tourniquets was excellent in 99% of the cases in group A, which was better than in group B (87%) (P<0.05).Conclusions The cerebrospinal fluid flow rate has much influence on the anesthesia plane and anesthetic effect. A cerebrospinal fluid velocity below 5 s and an injection speed of 0.1ml/s with 0.5% ropivacaine can yield satisfactory anesthetic effect. Anesthesiologists should adjust the drug injection rate according to the cerebrospinal fluid velocity in order to achieve the optimal anesthetic effect.