细针引导腰麻针径路的解剖特点与临床应用

The needle-guided spinal anesthesia: anatomic characteristics and clinical application

目的:评价细针引导腰麻针穿刺径路的解剖特点与其临床应用效果。方法:经尿道微创腔镜手术30例,用9号穿刺针置于皮下引导,25GWhitacre腰穿针通过9号穿刺针孔进行蛛网膜下腔穿刺,成功后拔出内芯,可见脑脊液外流,注入0.5%布比卡因2～3ml退针,立即平卧位。观察病人麻醉平面、血压变化及麻醉效果。结果:穿刺操作简单,全部病例完成腰麻,麻醉效果好,一次腰麻能够完成手术。术后随访无任何异常。结论:掌握正确的解剖要领作细针引导下腰麻穿刺可降低病人的损伤,是一种可行、安全及有效的麻醉方法。

Objective： To evaluate anatomic characteristics and clinical application of the needle-guided spinal anesthesia. Method： 30 patients suffering from minimally invasive surgery of transurethral endoscope were punctured subcutaneously with the 9th needle, and then conducted the subarachnoid puncture with 25-gauge Whitacre spinal needle through the needle. After successful puncture and withdraw of core, CSF flowed out. The needle was withdrewn after injecting 2-3ml 0.5% bupivacaine into subarachnoid cavity, while patients were taken the position of prostration. For all cases, anesthetized level, blood pressure and anesthetic effects were monitored. Results： This procedure was simple. All patients accepted spinal anesthesia obtained a good anesthetic effect, and operations can be performed smoothly during anaestheic time. Conclusions： The needle-guided spinal puncture is a viable, safe and effective anesthesia method, however, the operator have to be familiar with related anatomic features.