两点穿刺法在硬膜外腔-腰椎蛛网膜下腔阻滞联合麻醉中的应用

Application of two puncture in epidural cavity of lumbar subarachnoid space block anesthesia

目的探讨两点穿刺法在硬膜外腔．腰椎蛛网膜下腔阻滞麻醉（简称腰硬联合麻醉）中应用效果。方法回顾性分析50例应用两点穿刺法腰硬联合麻醉进行的经腹全子宫切除术患者的临床资料，统计分析心电图、心率、血氧饱和度、血压等变化情况，采用改良Bromage评分法判断运动神经阻滞情况及麻醉质量。结果50例均顺利完成手术，无需改变麻醉方式。运动神经阻滞及麻醉质量优良率为100％，腹肌及宫颈肌肉松弛质量优良率为100％，镇痛完全。无呼吸困难、胸闷、头疼等发生，术中补液量约1500ml，手术时间（135．0±4．5）min。48例患者血流动力学状态（SpO2、HR、BP）保持稳定，2例患者在麻醉后10min后出现血压下降，静脉注射麻黄碱10mg后恢复正常。术后患者均痊愈，无麻醉后神经系统并发症。结论两点穿刺法腰硬联合麻醉应用于全子宫切除术，麻醉效果确切，术后并发症少，应值得推广。

Objective To explore the effect of two puncture during epidural cavity of lumbar subarachnoid space block anesthesia（ referred to as combined spinal-epidural anesthesia）. Methods Clincal dato of 50 cases of application, two puncture method combined spinal-epidural anesthesia for abdominal hysterectomy Electrocardiogram, heart rate （ HR）, oxygen saturation, blood pressure （ BP ） changes were analyed were retrospectively analyzed, using modified Bromage scoring method to determine motor nerve block and the quality of anesthesia. Results 50 cases were successfully completed operation, without changing the mode of anesthesia. Motor nerve block anesthesia and quality excellent rate was 100%, the abdominal and cervical muscle relaxation quality excellent rate was 100%, analgesia was completely. No difficulty in breathing,chest tightness ,headache ,intraoperative fluid infusion about 1500ml, operation time （ 135.0 ±4.5 ） min. 48 patients hemodynamie status （ SpO2, HR, BP） remained stable, 2 patients after anesthesia 10min appeared a drop in blood pressure,intravenous injection ephedrine 10rag returned to normal. Postoperative patients were cured, no neurological complications after anesthesia. Conclusion Two puncture lumbar epidural combined anesthesia applied to hysterectomy had good, anesthesia effect, less complications, should be worthy of promotion.