不同椎管内麻醉方法在腰椎间盘摘除术中的应用

Comparison of application of different intraspinal anesthetic techniques during lumbar intervertebral disectomy

目的比较不同椎管内麻醉方法在L3以下腰椎间盘摘除术中应用的优缺点,为临床麻醉提供参考。方法将ASAⅠ～Ⅱ级拟行腰椎间盘摘除术病例随机分为三组,分别实行硬膜外麻醉(E组),等比重液腰麻(Ⅰ组)或重比重液腰麻(H组),观察麻醉效果、病人的反应、血流动力学变化、伤口疼痛及自解小便的时间等。结果Ⅰ组和H组较E组起效快,麻醉效果好。I组的低血压发生率和感觉不适率低于H组。Ⅰ组恢复自解小便的时间明显较H组早。结论在腰椎间盘摘除术中,等比重液腰麻起效快,镇痛完善,血流动力学稳定,对病人造成的不适感少,具有明显的优越性。

[Objective] To reveal the advantages and disadvantages of the application of different intraspinal anesthetic techniques so as to give reference to our clinical practice. [Method] 150 ASA physical status Ⅰ～Ⅱ patients undergoing lumbar intervertebral disectomy were allocated to 3 groups with 50 cases each. In lateral decubitus, patients randomly received an epidural injection (group E), a subarachnoid injection of 3.0 mL (15 mg) isobaric (group I) or hyperbaric (group H) bupivacaine and then turned supine. Recored the hemodynamic changes and patients' response. After epidural or subarachnoid injection, recorded the time to onset, peak sensory blocked level, the time to the first administration of analgesics for a significant pain of the incision, the time to recuperate the function of urination. [Result] Compared with group E, both group Ⅰ and group H provided more effective sensory and motor block for the operations with much shorter onset time. Compared with group H, the time to peak sensory block was longer, peak sensory block level was lower, time to the first require of analgesics was longer, time to recuperate the function of urination was shorter, the incidence of feeling sick, nausea, vomiting and hypotension was lower in group Ⅰ. [Conclusion] The advantages of spinal anesthesia with isobaric solution is evident--it provid effective anesthesia with shorter latent period, with relatively stabler hemodynamic characters, with lower incidence of patients' feeling sick, with longer duration of surgical anesthesia and analgesia and so forth. So spinal anesthesia with isobaric solution can best fit the surgery of lumbar intervertebral disectomy.