脊麻硬膜外联合麻醉时硬膜外试验剂量有效性的观察

The Efficacy of Epidural Test Doses during Combined Spinal-Epidural Anaesthesia

目的 观察脊麻硬膜外联合麻醉 (CSEA)时脊麻 (SA)作用是否影响含肾上腺素硬膜外试验剂量 (TD)的有效性。方法 2 5例 CSEA病人 ,静脉或硬膜外注射 2 %利多卡因 3ml(含肾上腺素 15 μg)。SA前仅静注 ,SA后 30～40 min时先后随机交叉间隔 10 min静脉和硬膜外注药。观察 SA最大平面和注药后峰 -峰 HR(ΔHR)、SBP变化 (Δ SBP)和自觉症状。以 ΔHR≥ 2 0次 / min、ΔSBP≥ 2 k Pa或有心慌、头晕为阳性循环反应。结果 1SA前后静注 TD后 SBP和 HR均明显增高 (P<0 .0 1) ,但硬膜外 TD无明显变化 (P>0 .0 5 )。 2 SA前和 SA中比较 ,ΔHR、ΔSBP和阳性循环反应率差异无显著性 (P>0 .0 5 )。 3SA后静注 TD时 ,ΔHR和 ΔSBP与 SA最大平面均无明显相关 (rs分别为 0 .316和 0 .0 5 7,P>0 .0 5 )。结论 CSEA时 SA作用并不影响 TD判断注入血管的准确性。

Objective To determine the effect of spinal anesthesia (SA) during combined spinal epidural (CSEA)on the efficacy of epinephrine test dose (TD)for the detection of uninteneional intravascular injection.Method Twenty five patients were received CSEA.TDs (epinephrine 15μg in 2% lidocaine 3ml)were injected intravenously before and 30～40min after SA and epidurally after SA.After SA,intravenous and epidural injection were randomjed,cross over with 10 minute interval.The maxinum cephalad levels of SA as well as peak to peak HR(ΔHR),changes of SBP(ΔSBP),the symptoms after injection of TDs were observed.Positive hemodynamic criteria were defined as ΔHR≥20 bpm,or ΔSBP≥2.0 kPa,or appearance of such symptom as palpation and dizziness.Result Intravenous TD increased HR and SBP both before and after SA didn't(P<0.01),where as epidural TD after SA did not (P>0.05).The hemodynamic responses of intravenous TD before and after SA were found between the ΔHR or ΔSBP of intravenous TD and the level of anesthesia (r s=0.316 and 0.057,respectively,P>0.05).Conclusion The presence of SA does not affect the efficacy of epinephrine TD for the detection of unintentionally intravenous injection by positive hemodynamic criteria during CSEA. [