简易针内针脊麻技术的临床应用

Clinical values of simplified needle within the needle technique for subarachnoid puncture

目的探讨简易针内针脊麻技术的成功率及安全性。方法拟行脐以下部位手术的患者200例,随机分为简易针内针穿刺组(SS组)和腰硬联合穿刺组(CS组)两组,每组100例,两组分别以8号注射针和硬膜外穿刺针作引导针进行脊麻穿刺,将退针并调整方向再进针视作再次穿刺,若三次不能成功即更换引导针。记录两组穿刺时间,分别比较两组穿刺成功率以及更换引导针的比例;记录穿刺过程中神经异感及硬膜外血管损伤发生情况;记录两组有无脊麻针折断、变形情况;随访患者腰痛及神经并发症发生情况。结果平均穿刺时间CS组明显长于SS组[(25.21±7.11)svs(33.71±11.52)s,(t=6.28,P<0.05)];两组一次、二次、三次穿刺成功率差异均无统计学意义(χ2分别=1.46、0.93、0.29,P均>0.05);SS组更换引导针的比例高于CS组(15.00%vs.3.00%,χ2=7.39,P<0.05);两组穿刺过程中神经异感差异无统计学意义(χ2=0.29,P>0.05);穿刺过程中无一例发生脊麻针折断、变形情况;穿刺过程中有酸胀不适感及术后腰痛患者CS组明显高于SS组(χ2分别=83.63、30.52,P均<0.05);两组均无神经并发症发生。结论简易针内针脊麻技术与腰硬联合穿刺技术具有相近穿刺成功率,且更简便快捷、损伤更小、安全性好;但对于穿刺困难患者或初学者,仍以硬膜外穿刺针引导穿刺为佳。

Objective To investigate efficiency and safety of simplified needle within the needle technique for spinal anesthesia. Methods Two hundred patients of the surgery site lower than the navel were randomly divided into group SS and group CS （n=lO0 each）. Syringe needle of size 8 in group SS and the epidural puncture needle in group CS were used to induce the 25G subaraehnoid puncture needle for spinal anesthesia. And it was counted as another puncture if the inducing needle was dropped out and the direction of puncture was changed. The inducing needle was then changed to the epidural puncture needle in group SS or to the syringe needle of size 8 in group CS if three times had tried according to the criteria. The time for subarachnoid puncture and the success rate and the ratio of paresthesia and the damage of blood in epidural space were compared between group SS and CS. Results There was statistically difference in mean time for subarachnoid puncture between group SS and CS（t =6.28 ,P〈0.05）. And there were no statistically differences in the success rate for the first time and the second time and the third time between group SS and group CS. And there was statistically difference in the ratio of changing the inducing needle （15% and 3% respectively, X^2=7.39,P〈0.05）. There were no statistically differences in the cases of paresthesia and in the damages of blood in epidural space during the punctures. No needle was broken or deformed in group CS and group SS. And there were statistically differences in the number of patients with the uncomfortable feeling at the puncture point during and after the punctures （X^2=83.63,30.52,P〈O.05）. Conclusions The simplified needle within the needle technique for subarachnoid puncture is safe and has the same success rate as that of combined spinal-epidural anesthesia. It has much advantage than the latter, such as much simpler and faster, less damages ,but to the situation of difficult to puncture or to the beginner, combined spinal-epidural anesthesia may be needed .