腰-硬联合麻醉不同穿刺间隙在泌尿外科手术中的麻醉效果比较

目的 探讨不同穿刺部位对腰=硬联合阻滞麻醉对于泌尿外科手术的麻醉效果.方法 选取泌尿外科手术患者108例,按数字表法随机分为两组（A组和B组各54例）,两组患者均采用腰=硬联合麻醉,A组患者麻醉穿刺点为腰2～3椎间隙,B组患者麻醉穿刺点为腰3～4椎间隙,比较两组患者的麻醉前后血压、初始麻醉平面、达T6平面的时间、术中追加利多卡因药量、麻醉优良率和麻醉不良反应情况.结果 A组患者麻醉5 min血压显著低于B组（t=2.73、2.29、2.29,均P＜0.05）;B组恶心呕吐、低血压、呼吸困难不良反应发生率（24.1％、14.8％、1.8％）明显低于A组不良反应发生率（44.4％、33.3％、13.0％,x2=4.97、5.07、4.86,均P＜0.05）;A组初始麻醉平面明显高于B组（t=2.91,P＜0.05）,A组达T6平面的时间明显短于B组（t =2.42,P＜0.05）,A组术中追加利多卡因的量明显少于B组（t=2.61,P＜0.05）,两组患者的麻醉优良率无显著差异（P＞0.05）.结论 在泌尿外科的手术麻醉过程中,选取L3-4穿刺点比L2-3穿刺点进行腰=硬联合麻醉能明显地减少恶心呕吐、低血压、呼吸困难等不良反应发生率,减轻术中痛苦;两组初始麻醉平面、达T6平面时间、追加利多卡因药量虽有显著差别,但在临床中意义不大,对麻醉优良率没有影响.

Comparisons of combined spinal-epidural anesthesia in different puncture of gaps in urologic surgery anesthesia

Objective To explore the narcotic effects of different puncture in combined spinal-epidural block anesthesia for urological Surgery.Methods 108 cases of urologic surgery were selected.The patients were randomly divided into the two groups according to digital meter （each group had 54 cases）.Both groups were treated with combined spinal-epidural anesthesia.The anesthesia puncture of group A were in lumbar intervertebral 2-3,the anesthesia puncture of Group b were in lumbar intervertebral 3-4.The respects of the two groups were observed and compared such as blood pressure before and after anesthesia,initial anesthesia plane,the time the drug arrived to the sixth thoracic vertebrae,additional lidocaine dose during the operations anesthesia quality rate and anesthesia side effects.Resuits The blood pressures of the patients of group A were significantly lower than those of group B 5 minutes after anesthesia （t =2.73,2.29,2.29,all P ＜ 0.05）,the incidence of adverse reactions of Group B such as nausea,vomiting,low blood pressure,difficulty in breathing （24.1％,14.8％）,was significantly lower than incidence of group A （44.4％,and 13.0％,x2 =4.97,5.07,4.86,all P ＜ 0.05） the set of initial plane of anesthesia of group a was significantly higher than that of group B （t =2.91,P ＜ 0.05）,the time the drug arriving to the sixth thoracic vertebrae,of group A was significantly shorter than group B （t =2.42,P ＜ 0.05） the amounts of additional lidocaine dose of Group A during the operations were significantly less than group A （t =2.61,P ＜ 0.05）.There were no significant differences in the anesthesia quality rate （P ＞ 0.05）.Conclusion Selecting L3-4 puncture points in combined spinalepidural anesthesia can significantly reduce incidence of adverse reactions such as nausea,vomiting,low blood pressure and difficulty in breathing compared with selecting L2-3 puncture during urology surgery procedure.It can also reduce pain during operations.Though there are significant differences in in