硬脊膜穿破后原位实施硬膜外阻滞43例

Extradural Block in Situ for 43 Patients after Puncture of Spinal Dura Mater

目的 总结硬脊膜穿破后原位实施硬膜外阻滞的可行性和安全性。方法 确认硬脊膜穿破者，立即缓慢退针至硬脊膜外间隙，并注射无菌生理盐水15-20ml，向头端置管3-5cm,取平卧位，用试验剂量1．73％碳酸利多卡因3ml，持续监测生命体征、阻滞范围，并观察有无异常现象，待麻醉平面固定，再按照连续硬膜外阻滞给药。结果 43例全部麻醉满意，除5例术后有轻微疼痛外，其余无任何蛛网下隙阻滞的相关并发症。结论 硬脊膜穿破后继续行硬膜外麻醉，只要严密观察，分次,少量给药,是安全可行的。

Objective To sum up the feasibility and safety of extradural block in situ after puncture of spinal dura mater. Methods The puncture needle was pulled back to extradural space as soon as spinal dura mater was punctured, and then physiological saline solution （3-5 ml） was injected in. A tube was placed 3-5cm in the direction of the patient＇s head before he or she took horizontal position. At first, an experimental dose of lidocaine （ 1.73%, 3ml） was injected in, and then it was applied for successive extradural block. Results All the 43 patients were anesthetized satisfactorily except five ones with slight pain. Conclusion Extradural block after puncture of spinal dura mater is safe and feasible as soon as it is performed under careful observation.