硬膜外两间隙麻醉对兰尾炎手术脐部牵涉痛的影响

Influnce of two space epidural anesthesia on involvement pain of navel part by the appendicitis operation

目的:观察硬膜外两间隙麻醉对兰尾炎手术脐部牵涉痛的抑制效果。方法60例ASAⅠ～Ⅱ级硬膜外麻醉下兰尾炎手术病人随机分为两间隙麻醉(A组)和一间隙麻醉(B组)两组,每组30例。A组与T12～L1和T9～T10分别给予1.8%的利多卡因18ml和1%的利多卡因8ml。B组与T12～L1给予1.8%的利多卡因20ml,麻药中加入1︰20万的肾上腺素。术中吸氧,监测MAP、HR、RR、SPO2;观察脐部牵涉痛(VAS)程度,麻醉范围(T～L)以及辅助镇痛药等情况。结果两组MAP、HR、RR、SPO2无显著变化;A组脐部牵涉痛(VAS)评分(2.8±0.8)与B组(6.6±1.6)比较,P<0.05。麻醉范围A组(T5～L2)与B组(T8～L2)比较,P<0.05。辅用镇痛药A组【4例(13.3%)】与B组【14例(46.6%)】比较,P<0.05。结论硬膜外两间隙麻醉使麻醉阻滞范围扩大,从而有效减轻了阑尾炎手术时脐部牵涉痛的程度,且无明显不良反应发生。

Objective To observe effects of two space epidural anesthesia on involvement pain of navel part by the appendicitis operation. Methods 60 patients undergoing appendicitis operation randomly divided into two space group （A） and one space group （B） with 30 cases each. Group A received 1.8% xylocaine 18ml at the T12-L1 and 1% xylocaine 8ml at the T9-T10 ;group B received 1,8% xylocaine 20ml at the T12-L1 .The MAP HR , RR, SPO2 , pain rating （VAS） ,confines of anesthesia and the use rate of drug with analgesia were observed and recorded in operation .Results The VAS in geoup A （2.8 - 0.8） was lower than that in group B （6.4 ± 1.6） （P〈0.05） ; The confines of anesthesia in group A （T5- L2） was larger than that in group B （T8-L2 （P〈0.05） ;The use rate of drug with analgesia in group A （13. 3%） was lwoer than that group B （46.6%） （P〈0.01） .Conclusions Because of confines of anesthesia enlarge , two space epidural anesthesia can decrease the incidense of involvement pain of the navel part by appendicitis operation with less the side effects .