两点穿刺甲磺酸罗哌卡因腰-硬联合麻醉在腰椎手术中的应用

Combined Spinal-epidural Anaesthesia with Ethanesulfonic Acid Ropivacaine by Two-point Punctrues for Lumbar Vertebral Operation

目的：探讨两点穿刺甲磺酸罗哌卡因腰一硬联合麻醉在腰椎手术中应用的可行性。方法：选择103例腰椎手术患者．随机分为2组，其中腰一硬联合麻醉（CSEA）组62例，硬膜外麻醉（EA）组41例。CSEA组选择2个穿刺点：①选择胸12-腰1间隙硬膜外穿刺向尾侧置入硬膜外导管3．0cm。②在腰3-4间隙或腰椎板缺如处，以25G笔尖式蛛网膜下腔穿刺针穿刺，见脑脊液（CSF）回流后用15—20秒的时间注入0．298％甲磺酸罗哌卡因3ml。EA组选择胸12-腰，或腰1-2间隙进针，向尾侧置入硬膜外导管3．0cm．分次注入0．447％甲磺酸罗哌卡因10-15ml。观察麻醉起效时间、维持时间、麻醉平面，止痛效果，下肢运动功能及血压、心率、动脉血氧饱和度（SpO2）。结果：①麻醉起效时间CSEA组2—5分钟，EA组12-15分钟；维持时间两组均在2．5—3．0小时；麻醉平面平均在胸。。②止痛效果：CSEA组1级53例（85．48％），Ⅱ级9例（14．52％），Ⅲ、Ⅳ均为级0例（0．00％），止痛效果完善，起效快，EA组1级16例（39．02％），Ⅱ级20例（48．78％），Ⅲ级4例（9．76％）．Ⅳ级1例（2．44％），止痛效果较好，起效慢，两组止痛效果比较，差异具有非常显著性意义（P〈0．01）。③两组下肢运动阻滞差异无显著性意义（P〉0．05）。④术中血压、心率、呼吸两组无差异，SpO2均在98％以上。结论：在腰椎手术中行两点穿刺甲磺酸罗哌卡因腰一硬联合麻醉效果优于硬膜外麻醉。

Objective..To probe into feasibility of injected Ethanesulfonic Acid Ropivacaine by two-point punctures during the lumbar-vertebral operations. Methods： 103 cases with lumbar-vertebral operations were randomly divided into combined spinal-epidural anaesthesia group （CSEA group, n = 62 ）and epidural anaesthesia group （EA group,n = 41 ）. Two points were selected for puncture in CSEA group. （1）The first puncture point was located between Ti2 and Lt 3.0 cm outside the epidural catheter. （2）The second was located between L3 and L4, or at absent place of lumbar spine plate O. 298% Ropivacaine mesylate（ 3 ml）was injected in 15-20 sec with 25G transfixion pin. In the EA group, punctures were selected between Ti2 and LI 3.0 cm outside the epidural catheter or Ll and L2, 10-15 ml Ropivacaine Mesylate（0. 447% ）was injected fractionatedly. The time of anaesthetic emergence, maintainance, and the anaesthetic level were observed ; the analgetic effect was assessed, movement signs of the lower limbs were observed, blood pressure, heart rate, respiration and SpO2 were .observed. Results-（1）In the CSEA group,the time of aneasthetic emergence was 2-5 min,and 12-15 min in the EA group. The time of anaesthetic maintainance was 2.5- 3.0 hours equally in the two groups. The anaesthetic level was at T8. （2）Anaesthetic effects in the CSEA group were as follows：Grade 1 ,53 cases（85.48% ）. Grade Ⅱ ,9 cases （14.52%）. Grade Ⅲ and Ⅳ ,0 case （0. 00% ）. the analgetic effect was perfect and anaesthetic emergence was quick. In EA group,Grade 1 ,16 cases（39.02% ）. Grade Ⅱ ,20 cases（48.78% ）. Grade Ⅲ ,4 cases（9.76% ）. Grade IV .1 case （2.44%）. the analgetic effect was good but the emergence was slow. There was a significant difference between the analgetic effect of the two groups （P 〈 0. 01 ）. （3）There was no significant difference in the lower limbs hold-up in the two groups （P 〉 0. 05 ）. （4）There were no difference in blood pressure,heart rate and respiration during operations between the two groups,and SpO2 was above 98% in all patients. Conclusion： When used with Ethanesulfonic Acid Ropivacaine mesylate,the combined spinal-epidural anaesthesia is better than the epidural anaesthesia alone for lumbar vertebral operation.