改变硬膜外麻醉给药方法的临床探讨

Clinical Investigation of Epidural Anesthesia Effect of the Preinjection Saline in Epidural Cavity

39例ASAⅠ～Ⅱ级盆腔或下肢手术患者术前随机分成三组,每组13例.Ⅰ组首先经下管给予1:20万肾上腺素盐水0.1ml/cm身高,15min后再给予1.6%利多卡因(含1:20万肾上腺素)0.08ml/cm身高,此后间断测试麻醉起效时间、麻醉维持时间和麻醉最大平面,以及各时点Bp、HR.Ⅱ组首先经下管给予生理盐水0.1ml/cm身高,15min后给予1.6%利多卡因0.08ml/cm身高,其后测试同Ⅰ组.Ⅲ组仅经下管给予1.6%利多卡因0.08ml/cm身高,其后测试同Ⅰ、Ⅱ组.结果Ⅰ组镇痛节段最多(11.5±1.7),Ⅱ组其次(9.9±2.8),Ⅲ组最少(7.5±2.4),Ⅰ、Ⅲ组比较P<0.01,Ⅱ、Ⅲ组比较P<0.05.并且Ⅰ组8例、Ⅱ组7例盆腔手术患者凭下管麻醉即能完成手术,Ⅲ组仅2例凭下管麻醉完成手术,余6例肌松镇痛均不完善,需上管追加麻药方能完成手术.

Thirty-nine ASA patients with Ⅰ～Ⅱ grades undergoing lower limb surgery or gynecological procedures were divided randomly into three groups with 13 cases each. The patients in group A were first given saline 0.1 ml/cm height containing 1: 200 000 epinephrine via an epidural catheter inserted at the L2~3 interspace (lower place catheter),then 1.6% lidocaine 0.08 ml/cm height containing 1 ! 200 000 epinephrine 15 min later. The patients in group B were received saline 0. 1 ml/cm height via a lower place catheter at first, then 1. 6% lidocaine 0. 08 ml/cm height 15 min later. The patients in group C were received only 1. 6% lidocaine 0. 08 ml/cm height. The aneshesia setting out duration .maintenance duration .analgesia segment ,Bp,HR were measured. There was significant difference in analgesia segment between groups A and C (P<0. 01) and between groups B and C (P<0. 05)respectively. Eight patients in group A,7 in group B and only 2 in group C achieved successful gynecological procedures via the epidural catheter inserted at the L2～3 interspace.