硬膜外麻醉下躯干温度升高与痛觉缺失平面变化

Changes between levels of temperature elevation and sensory analgesic in patients with epidural anesthesia.

目的 观察在硬膜外麻醉下躯干温度升高平面与痛觉缺失平面的关系，探讨躯干皮肤温度测量的临床意义。方法 硬膜外麻醉手术的患者40例，随机在30例硬膜外腔中注入2％利多卡因（测试组），10例硬膜外腔中注入生理盐水（对照组），观察两组患者注液前和注液后5、10、15、20、25、30min的T4、T5、T6、T7、T8、T9、T10、T11、T12和L5皮肤温度变化，同时也测量测试组中各时间点痛觉缺失平面（针刺法），观察温度升高平面同痛觉缺失平面的关系。结果 测试组各时间点温度升高平面均高于痛觉缺失平面，在5、10、15、20、25、30min时间点，温度升高平面与痛觉缺失平面差分别为：2．5±0．6、2．8±0．7、2．3±0．5、2．4±0．5、2．4±0．5、2．4±0．5。测试组阻滞区T6、T7、T8、T9、T10、T11、T12、L5稳定温度升高值较对照组的相应点的稳定温度升高值升高明显（P〈0．01）。结论 硬膜外麻醉下阻滞区皮肤温度呈节段性升高，且温度升高平面均高于痛觉缺失平面2～3脊神经节段。

Objective To observe the change between levels of temperature elevation and sensory analgesic in patients with epidural anesthesia , to explore the clinical use of skin temperature elevation. Methods The 40 patients, which epidural catheter was inserted at the L2-L3 interspace, were randomly assigned to epidurally injectal water （control group n ： 10） or 2 percent lidocaine （experiment group n = 30）. The changes in the skin temperature in T4, T5, T6, T7, T8, T9, T10, T1 T12, L5 were observed at the time intervals before epidural injection 5,10,15,20,25 and 30 min after epidural injection, meanwhile , the levels of sensory analgesic to pinprick were measured. Results In the experiment, the uppermost level of temperature elevation was cephalad to the upper limit of sensory analgesic to pinprick. The mean temperature-sensory analgesic differential levels were 2.5 ± 0.6,2.8 ± 0.7,2.3 ± 0. 5,2.4 ± 0. 5,2.4 ± 0. 5,2. 4 ± 0. 5 at the time 5,10,15,20,25and 30min after epidural injection, respectively. In the experiment group , the net increases in skin temperature at the T6 ,T7, T8, T9, T10 ,T11 ,T12 and Ls were higher than those observed in the same regions of the control group （P〈0. 01 ）. Conclusion The skin temperature is elevated in segments with epidural anesthesia, the levels of the skin temperature of the trunk are higher 2-3 segments than the levels of sensory analgesic to pinprink.