细针穿刺引导置管腰硬联合麻醉的可行性研究

目的:探讨细针穿刺导丝引导置管腰硬膜外联合麻醉(CSEA)方法的可行性,以减少硬膜外麻醉后腰背痛的发生率和严重程度。方法:100例择期下腹、下肢手术ASAI级～II级病人,年龄16岁～60岁,随机均分为两组:细针穿刺导丝引导置管CSEA组(I组)和18#Touhy针CSEA组(II组)。I组用9#8cm长细针行硬膜外穿刺,成功后用26G腰麻针通过细针内穿刺施行腰麻;腰麻成功后退出26G针,从9#针内置入"S"形硬膜外导管导丝后退出细针,导管套入导丝,送入硬膜外腔;II组采用经典的针内针法腰硬联合麻醉。两组所用药物种类、剂量和硬膜外腔留管长度5cm相同。术后用相同药物行病人自控硬膜外镇痛2d。观察并记录两组操作所用时间、一次置管成功率、有无异感、首次药量、手术时间、麻醉效果、术后疼痛和手术后第3天、第5天、第7天、第9天腰背痛情况的视觉模拟评分法(VAS)评分。结果:两组操作所用时间、一次置管成功率、穿刺或置管异感、首次药量、手术时间、麻醉效果、术后疼痛VAS评分差异无明显性(P>0.05),但手术后第3天、第5天、第7天、第9天腰背痛VAS评分I组明显低于II组(P<0.01)。结论:细针穿刺导丝引导置管CSEA不仅减少硬膜外麻醉后腰背痛的发生率和严重程度,而且是安全可行的。

Feasibility of combined spinal-epidural anesthesia with 20 G thin needle puncture and putting tube by wire guide for reducing postpunctural lumbago

Objective To investigate the validity and security of combined spinal-epidural anesthesia （CSEA） with 20 G thin needle puncture and by guidance to set tube for reducing the incidence and severity of postpunctural lumbago.Methods 100 cases of elective lower abdomen, lower extremity surgery ASA I-II patients, aged 16 to 60,were randomly divided into two groups： observed group （group I） and control group （group II）.In group I,puncture with 9 # 8cm long needle after local lanes thesia to enter epidural space exactly, first, carry out spinal anesthesia with 26 G needle through the needle.Second, from the needle embedded into the ＂S＂ shape stainless steel wire after to withdraw 26 G needle and pulling out the needle subsequently, then putting the epidural catheter on the guide wire and pushing into the space, implementing CSEA.In group II used the classic combined spinal and epidural needle implementing CSEA.The type and dosage of drugs used, and length of the tube remained epidural space-5 cm were the same. The postoperation patient-controlled epidural analgesia using the same drugs performed two days.The operating time,success rate of tube implantation, preternatural feeling, first dose of drugs, duration of operation,anesthetic effect,VAS score of postoperative pain and postpunctural lumbago after operation in two groups were observed and recorded.Results The operating time,success rate of tube implantation, preternatural feeling, first dose of drugs, duration of operation,anesthetic effect, VAS score of postoperative pain were no significant difference in both groups （P〉0.05）;But VAS score ofpostpunctural lumbago at 3th, 5th,7th and 9th days in group I was significantly lower than in group II （P〈0.01）.Conclusion The combined spinal-epidural anesthesia with 20G thin needle puncture and putting tube by wire guide not only reduce the incidence and severity ofpostpunctural lumbago but also is safe and feasible.