经硬膜外穿刺针注入利多卡因对剖宫产术连续硬膜外麻醉效应的影响

Effect of lidocaine administering via epidural needle on continuous epidural anesthesia in caesarean section

目的评价经硬膜外穿刺针注射局麻药后再置管对剖宫产术连续硬膜外麻醉效应的影响。方法单胎足月妊娠拟在连续硬膜外麻醉下行子宫下段剖宫产术的产妇100例,ASAⅠ或Ⅱ级,随机均分为研究组(P组)和对照组(C组)。硬膜外穿刺成功后,P组先通过硬膜外针注入2%利多卡因,注射完后保持注射器压缩针栓20 s,使液体充分扩散后再置入硬膜外导管;C组置入硬膜外导管后再注入2%利多卡因。记录置入硬膜外导管时的不良反应;测量给药完毕后20 min的麻醉平面,并评估麻醉满意度;记录置管时主诉异感和发生单侧阻滞的例数。结果与C组比较,P组硬膜外穿刺针针尾见淡红色血水的发生率(14%vs.36%)、硬膜外导管回抽出淡红色血水的发生率(4%vs.16%)明显降低(P<0.05)。P组利多卡因用量为(312±18)mg,明显少于C组的(355±32)mg(P<0.01)。给药后20 minP组的麻醉平面达T_(5.6±0.8),明显高于C组的T_(6.5±1.1)(P<0.01),且麻醉满意度显著增加(96%vs.84%)(P<0.01)。结论硬膜外置管前从硬膜外针注入局麻药不仅能有效减少置管对剖宫产产妇硬膜外血管的损伤,而且还能显著提高麻醉效果,减少局麻药的用量。

Objective To evaluate 2% lidocaine administering via epidural needle before catheter insertion during caesarean section Methods A total of 100 ASA I or II term singleton parturient, undergoing caesarean section followed by continuous epidural analgesia were randomly divided into two groups（n= 50）. After identification of the epidural space, patients in group C received direct epidural catheter insertion followed by local anesthetic via the catheter. Patients in group P received local anesthetic via the epidural needle, 20 s of syringe holding in order to dilate the epidural space and then catheter insertion. Adverse effects during catheter insertion and anesthesia satisfaction were recorded. Results Compared with group C, the incidence of bloody water in the backshank of epidural needle, the cases with pumpbacking bloody water from epidural catheter were obviously lower than those （P〈0.05） in group P, while the dosage of lidocaine was significantly lower （P〈0.01）. Both the anesthesia levels and the anesthesia satisfaction were significantly higher in group P（P〈0.01）. Conclusion Local anesthetic administering through the epidural needle before catheter insertion can reduce the incidence of vascular injury, reduce local anesthetic need and improve anesthesia quality.