剖宫产手术行腰硬联合麻醉腰麻针开口方向的比较

Comparison of Efficacy and Safety of Needle Tip Opening Directions in Combined Lumber and Epidural Anesthesia for Cesarean Section

目的研究腰硬联合麻醉时腰麻针不同的开口方向,对剖宫产手术开皮前生命体征、用药情况、感觉阻滞起效时间、麻醉阻滞平面及开皮时间的影响。方法 210例行剖宫产手术的病例,按蛛网膜下腔麻醉时针口方向分为2组,针口斜面向头为A组,共112例;针口斜面向尾为B组,共98例。注药后平躺,随即将孕妇左斜30°。结果 A组较B组蛛网膜下腔注射药后1min生命体征变化明显,左侧卧位后无明显改善,多数需用药改善生命体征,2组比较差异有统计学意义(P<0.01)。卧位后至开始切皮时间以及感觉阻滞起效时间差异无统计学意义(P>0.05)。结论 腰硬联合麻醉用于剖宫产手术,腰麻针口斜面向尾,对生命体征影响小,用药概率减少,可作为剖宫产手术一种较佳的麻醉方法。

Objective：To assess the efficacy and safety of combined spinal-epidural anesthesia with needle opening in different directions for cesarean section before and after the skin insician was made.Vital signs,drug use,sensory block onset time,anesthesia time,the level of nerve blockage and the impact of skin incision were compared.Methods：Totally 210 cases who underwent routine elective caesarean section were enrolled into this study.They were divided into two groups according to the direction of spinal anesthesia clock port,group A with the inclined plane of the needle tip opening to the head（112 cases） and group B to the cauda（98 cases）.After injection of the anesthetics with the pregnant women in lateral decubitus position,they were kept in left oblique 30° position.Results：The vital signs changed significantly（P0.01） one minute after injection in group A as compared to group B and the left lateral position could not result in significant improvement,the majority of the cases in group A needed medication to improve the vital signs.There were no significant differences in time to skin incision as well as the onset time of sensory block（P0.05）.Conclusion：In combined spinal and epidural anesthesia for cesarean section,the inclined plane of the spinal anesthesia needle tip opening to the direction of cauda of the patient had little influence on the vital signs,medication risk reduction in caesarean section.Therefore,this method may be a better one in anesthesia for caesarean section.