硬膜外腔麻醉穿刺置管困难的临床观察

Epidural Puncture Catheter into the Blood Vessels Precursor Indications and Methods to Circumvent

目的:通过大样本观察硬膜外穿刺置管困难的情况及解决方法。方法:2 000例需行硬膜外麻醉的患者,在施行硬膜外穿刺置管时根据置管过程中是否遇到阻力分组。置管过程顺畅未遇明显阻力者归入A组;置管中遇到明显阻力并出现神经刺激症状者归入B组;置管中遇到阻力但无神经刺激症状者依据该患者住院号末位数的奇偶性分别归组(设定0为偶数),奇数者归入C组,偶数者归入D组。C组采用加压平推法置管,B组和D组采用旋入法置管。观察各组患者的例数及置管结果。结果:A组患者1 805例,B组患者16例,C组患者83例,D组患者96例。C组导管误入血管者42例,占50.6%,非常明显地高于其他各组(P<0.01),其他3组之间则无显著差异。结论:置管困难为导管抵触到硬膜外腔腔壁、腔内容物、粘连带或生理性纤维隔所致,其中较多见的因素是椎内静脉丛,传统的置管方法并发症多、失败率高,采用旋入法置管则可有效解决置管困难。

Objective：To observe the large sample epidural catheterization catheter into blood vessels and threatened to circumvent the indications and methods.Methods：1698 cases of need in patients with epidural anesthesia,in the implementation of epidural puncture tube under whether resistance division.Smooth tube obviously had not been encountered resistance from classified A group;tube does not smooth the process of obvious resistance encountered,the suspended tube,according to the number of patients with the bottom of its parity, respectively, to the group （ set 0 for even -numbered）, odd persons classified as B groups, even those classified as C group. Group B Ping pressurized tube method, C group screwed tube method. Tube after the completion of each group and the number of cases of patients with vascular catheter into the positive rate. Results ： A group of patients with the results of 1574 cases, B group were 54 cases, C group were 70 cases. B Group catheter into the blood vessels positive rate very significantly higher than A, C group （P 〈 0. 01 ）, A, C between the two groups had no significant difference. Conclnsions：tube does not smooth the process of resistance could serve as a conduit error precursor into the vascular indications, in the tube encountered resistance screwed law introduced after the tube can effectively prevent the catheter into blood vessels.