导管针法连续腰麻用于骨科下肢手术的临床效果

目的 探讨导管针(spinocath)法连续腰麻的临床效果、血流动力学改变及术后并发症,并与目前广泛应用的腰麻-硬膜外联合阻滞麻醉进行比较。方法40例择期骨科下肢手术患者随机分为两组,分别接受连续腰麻(CSA)或腰麻-硬膜外联合阻滞麻醉(CSEA)。记录麻醉操作时间,麻醉药的用量,麻醉后血压、心率的变化及感觉和运动阻滞程度。术后2d随访,记录有无术后并发症。结果CSA组有2例腰穿失败,改为硬膜外麻醉。两组麻醉操作时间相似[(12±2.0)vs(14.2±3.5)min]。麻醉完善时间两组无显著性差异[(15±2.1)vs(19±10.0)min],CSA组局麻药用量为(18±6.2)mg,CSEA组局麻药用量平均为(12.5±1.2)mg,组间无显著性差异。最高阻滞平面和运动阻滞程度两组间无显著性差异。CSEA组低血压的发生率高(3/20 vs 0/18),但无显著性差异。术后并发症两组间无显著性差异。结论 导管针法连续腰麻与腰麻-硬膜外联合阻滞麻醉相似,用于骨科下肢手术麻醉效果完善,血流动力学稳定,术后并发症少,尤其适用于心血管功能不稳定的老年患者。

Clinical study of continuous spinal anesthesia with spinocath technique in lower limb surgery

Objective To investigate the efficacy and complications of continuous spinal anesthesia with spinocath technique(CSA) using plain ropivacaine 0.5% and comparied with the widely used combined spinal-epidural technique( CSEA). Methods Forty trauma patients received either CSA and CSEA randomly. An initial subarachnoid bolus of 2ml 0.5% plain ropivacaine was injected. If anesthesia did not reach T10) within 20 min, supplemental ropivacaine was injected either intrathecally or epidurally up to a maximum of 5ml in the CAS group or 15ml in the CSEA group. Mean arterial blood pressure, heart rate,analgesia level, total dosage, and post operative complaints were recorded. Results The demographic data were comparable between the two groups. More patients in the CSEA group were treated for hy-potention(3 vs 0);There were no postoperative complaints interviewed in two groups. Conclusions In our study, spinocath technique for CSA is safe, efficient and provides better hemodynamic stability than CSEA without increasing the rate of complains. So it might be preferred over CSEA in elder patients scheduled for lower limb surgery.