脊麻-硬膜外联合阻滞麻醉术后病人平卧方式改进的探讨

Improvement of supine approach of postoperative patients with combined spinal - epidural anesthesia

目的通过观察比较脊麻-硬膜外联合阻滞麻醉术后病人不同卧位的舒适度和头痛发生率，探讨脊麻-硬膜外联合阻滞麻醉术后病人垫枕平卧的可行性。方法选择300例下腹部、下肢部位手术病人，18～60岁，全部采用笔尖式25G脊麻针、针内针法行脊麻-硬膜外联合阻滞麻醉。随机平分为观察组和对照组，观察组术后垫枕平卧，枕头高度以病人感觉舒适为适度，不限制头部活动。对照组则术后去枕平卧6h以上，限制抬头等活动。术后连续随访3d，记录两组病人的舒适度和头痛发生情况，并进行统计学处理。结果两组病人术后均无头痛发生，观察组病人的舒适度明显优于对照组（P〈0．01）。结论25G笔尖式脊麻针行脊麻一硬膜外联合阻滞麻醉术后病人垫枕平卧是可行的。与传统的脊麻术后常规去枕平卧6h相比，避免了强迫体位，且舒适度增加。

Objective To observe and compare the degree of comfort and the incidence of headache in different supine approach of postoperative patients with combined spinal - epidural anesthesia, and to discuss the feasibility of prostrated with pillow. Methods We choosed 300 patients underwent the lower abdomen or lower limb surgery, who were 18 to 60 years old. All of the patients with pen - type 25G spinal needles in needle spinal -epidural anesthesia. The patients were randomly divided into observed group and the control group. Observed group were prostrated with pillow, that pillow＇ s height was appropriate, so that the patients reeled comfortable, without head movement restricting. Control group were prostrated without pillow for more than 6 hours,and restrictng head movement. We continuously and randomly visited 3 days after operation, recording the degree of comfort and the incidence of headache in the two groups with analyzing statistically. Results Both groups had no headache after operation, and the degree of comfort of the observed group was better than that of control group（ P 〈0. O1 ）. Conclu- sions Prostrating with pillow was feasible for spinal - epidural anesthesia postoperative patients with 25 G spinal needle tip type. Comparing with spinal anesthesia with the traditional prostrating position for 6 hours, it avoided the forced posture and increased comfort.