坐位细针腰麻在急诊剖宫产术中的临床应用

目的探讨坐位细针腰麻在急诊剖宫产术中的临床应用效果。方法选择急诊剖宫产术产妇400例，美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级，按照随机数字表法分为4组（每组100例）：A组，坐位笔尖样细针腰麻组；B组，侧卧位笔尖样细针腰麻组；C组，坐位普通斜面针腰麻组；D组，侧卧位普通斜面针腰麻组。穿刺成功后注入0．5％布比卡因1．8ml～2．2ml（9mg—11mg）。术毕待麻醉平面消散至T10以下后，送回病房去枕平卧6h，第1、2、3天及时随访。观察记录4组产妇的血压、脉搏血氧饱和度和心率的变化，记录腰麻穿刺次数、穿刺成功率、麻醉操作时间、穿刺开始到切皮时间、切皮到胎儿娩出时间以及术中、术后副作用。结果与B组和D组比较，A组和C组（即两组坐位与两组侧卧位比较）穿刺次数减少B组（3．2±0．9）和D组（4．1±0．4），A组（1．1±0．5）和C组（1．2±0．6）]、穿刺成功率提高B组（90％）和D组（92％），A组（100％）和C组（98％）]、穿刺时间缩短B组（5．2±0．6）min和D组（4．1±0．9）min，A组（1．2±0．8）min和C组（2．1±0．7）min]、麻醉操作时间缩短B组（7．1±0．5）min和D组（6．2＋0．8）min，A组（3．4±0．7）min和C组（4．3±0．6）min]、从穿刺开始到切皮时间缩短B组（15．2±6．3）min和D组（17．1±4．4）min，A组（10．4±0．5）min和C组（11．3±0．7）min]（P〈0．05）。与C组和D组比较，A组和B组（即两组细针与两组普通针比较）术中低血压发生率降低C组（18％）和D组（20％），A组（8％）和B组（10％）]、恶心呕吐发生率减少C组（10％）和D组（12％），A组（4％）和B组（5％）]、无术后头痛和腰痛发生C组（3％）和D组（4％），A组（0）和B组（0）]（P〈0．05）。结论坐位细针腰麻，操作简便，所需时间短，穿刺次数少，成功率高，术中、?

The clinical practice of sitting position with pencil point spinal needle for spinal anesthesia in emergency cesarean section

Objective To study the effects of sitting position with pencil point spinal needle in spinal anesthesia for emergency Cesarean-section. Methods Four hundred ASA physical status of I or II parturients undergoing emergency cesarean section were divided randomly into four groups （100 cases each）. Spinal anesthesia was performed with pencil pointed needle in sitting position in group A, or with pencil pointed needle in lateral position in group B, or with ordinary inclined plane needle in sitting position in group C, or with ordinary inclined plane needle in lateral position in group D. Spinal anesthesia was induced with 1.8 ml-2.2 ml of 5% bupivacaine （9 mg-11 mg） following successful puncture. The parturients were escorted to wards when analgesia block level dissipated to T10 after operation. All patients must be in supine position for six hours. Postoperation follow-up lasted for three days. The frequency of puncture, puncture time, the rate of successful puncture, the time from skin incision to delivery. Intraoperation and postoperative complications were recorded. Results Compared with group B and D, the frequency of puncture were declined significantly in group A and C group B（ 3.2±0.9 ） and D（4.1±0.4） vs group A（ 1.1 ±0.5 ） and C （1.2±0.6）], the rate of successful puncture were increased group B （90%） and group D （92%） vs group A （100%） and group C （98%）],the time of puncture were shorter group B （5.2±0.6） min and D （4.1±0.9） min vs group A （1.2±0.8） min and C （2.1±0.7） mini, the time of performed spinal anesthesia were shorter group B （7.1±0.5） min and D （6.2±0.8） min vs group A （3.4±0.7） min and C （4.3±0.6） mini, the time from beginning puncture to skin incision were shorter group B （15.2±6.3） min and D （17.1±4.4） min vs group A （10.4±0.5） min and C （11.3±0.7） mini （P〈0.05）. Compared with group C and D, the rate of intraoperation hypotension were reduced in group A and B group C（18%） and gr