椎管麻醉后神经并发症的治疗性研究

The Study on the Treatment of Neuro-complications after Ver-tebral Canal Anesthesia

目的本研究通过对椎管麻醉后常见神经并发症的临床观察与预防性治疗,减少其发生,促进神经功能的早期恢复。方法选择120例中下腹部手术行腰硬联合或硬膜外麻醉的术科病人,每组40例。Ⅰ组为术后常规镇痛组;Ⅱ组为术后常规预防治疗组;Ⅲ组为对照组。每大组根据穿刺置管时有无异感、胀痛等神经刺激症状分为两小组,每组20例。分别记录各组穿刺时的情况、血流动力学参数指标、术后神经功能障碍的发生、发展及处理情况。结果Ⅱ组与Ⅰ组在术后一天的MAP、P比较明显提高(P<0.05),Ⅲ组与Ⅰ组在术后一天的MAP、P比较有非常明显增加(P<0.01)。三组病人穿刺置管情况比较差异无显著性。Ⅱ组无1例发生术后神经功能障碍;穿刺置管时有无异感发生与术后神经功能障碍的发生没有直接的联系,穿刺置管时异感发生程度的轻重与术后神经功能障碍症状的严重程度和持续时间似有关联。发生术后神经功能障碍的病人经脱水及对症治疗均痊愈出院。结论及时、早期、预防性的硬膜外腔治疗可以明显降低术后神经功能障碍的发生率,促进患者康复,且此方法非常便于麻醉医生的临床应用。

Objective To explore effective ways to reduce neuro-complications and help earlier restoration of nerve function after vertebral canal anesthesia according to clinical observation and preventive therapy. Methods 120 ASA I or II patients undergone combined spinal-epidural anesthesia or epidural anesthesia were divided randomly into 3 groups （n=40 each）. Each big group basis is divided into two groups （20 example in each ） which depends on whether there is the symptom of the unusual feeling, nerve and so on when the drive pipe is on. Separately records each group of puncture situation, hemodynamics index, the development and processing situation of nerve function barrier after surgery. Results there are no significant difference among three groups of patients situation after puncture set on. Ⅱ group does not have one example of the nerve function barrier occurs after the surgery;there is no direct correlation between different feeling and nerve function barrier occurrence after the surgery; but there to seem be correlation of the degree between the different feeling and the nerve function barrier symptom after the puncture sets on. After the dehydration and the just right for the illness treatment, the nerve function barrier patient recovered. Conclusion The surgery the nerve function barrier formation rates may be obviously reduced through prompt, early, the prevention epidural canal treatment promotes, and to promote the patient to be restored to health. Moreover, this method is extremely advantageous for anaesthetizes doctor＇ s clinical practice.