1587例硬膜外阻滞药物扩散再认识

Research on the spread of local anesthetic in the epidural space of 1587 patients undergoing epidural blockade

目的探讨硬膜外阻滞初量在不同穿刺点的扩散情况。方法1 587例硬膜外阻滞病例,详细记录初量的阻滞节段数,并根据不同穿刺部位分别计算出阻滞每节段需要量。结果以穿刺点为界扩散,在中位穿刺点的向头和尾扩散无差别(P>0.05),在低位穿刺点向头扩散明显少于尾扩散(P<0.01);总扩散节段数中位穿刺点少于低位;中位和低位穿刺点阻滞每节段需要量分别为(1.42±0.62)m l和(1.17±0.48)m l(P<0.01),随穿刺点下移,节段需要量有减少趋势。结论中位穿刺点阻滞每节段需要量多于低位穿刺点,且向头端扩散不明显多于尾端。

Objective To explore the relationships between the spread and the initiative dosage of local anesthetic given at different levels of epidural puncture. Methods The number of dermatomes blocked was determined after giving an initiative dose of anesthetic in 1 587 patients undergoing epidural anesthesia. The required dose to induce analgesia per dermatome was calculated. Results No significant differences were found between the numbers of dermatomes blocked in the cranial and caudal directions in middle epidural blockade （ P 〉 0.05）, but in low epidural blockade, less dermatomes were blocked towards the cranial end than towards the caudal end （ P 〈0.01 ）. The total number of dermatomes blocked in middle epidural blockade was less than that in the low epidural blockade. The dose of local anesthetic per dermatome was （ 14.2 ± 0.62） ml for middle epidural blockade, bigger than （ 1.17 ± 0.48） ml for low epidural blockade （ P 〈0.01 ）. The dosage per dermatome was decreasing with the lowering of puncture level. Conclusion The dosage of local anesthetic per dermatome is significantly bigger in middle epidural blockade than that in low epidural blockade, but there is no difference between the cranial spread of drug and the caudal spread in the former ease.