腰硬联合麻醉留置尿管时机选择的研究

Selection of timing for placement of indwelling catheter in patient receiving combined spinal and epidural anesthesia

目的探讨实施腰硬联合麻醉患者留置尿管的最佳时机。方法选择300例行腰硬联合麻醉的患者，将其随机分A、B、C三组，分别有93、102、105例。A组在腰硬联合麻醉前留置尿管，B组在腰硬联合麻醉后5min内留置尿管，C组为腰硬联合麻醉后5min后留置尿管。所有患者分别在导尿前、导尿操作期间即刻记录血压、心率。在导尿后按疼痛程度评定标准评定j组患者在导尿操作过程中的疼痛程度。结果与A、B两组患者相比，腰硬联合麻醉后5min后留置尿管的c组患者在操作期间的收缩压（F=28．523，P=0．036）、舒张压（F=19．674，P=0．001）、心率（F=8．523，P=-0．042）无明显变化，疼痛不适发生率最低（x^2=16．415，P=0．025），且插管成功率最高（x^2=11．631，P=0．042），差异有统计学意义。结论手术患者腰硬联合麻醉后5rain后留罟尿管时机最为适官。

Objective To investigate the optimal timing for placement of indwelling catheter in patients receiving combined spinal and epidural anesthesias （ CSEA ）. Methods A total of 300 patients receiving combined spinal and epidural anesthesia were randomly divided into 3 groups. Group A received placement of urethral catheter before CSEA, Group B received placement within 5 minutes after CSEA, and Group C received placement more than 5 minutes after CSEA. Blood pressure, heart rate, level of procedure associated pain, and rate of successful intubatinn were compared among the three groups. Results As compared with groups A and B, there were no obvious changes in systolic pressure （ F= 28.523, P= 0. 036 ） and diastolic pressure （ F= 19.674, P-- 0.001 ） and heart rate （ F= 8.523, P= 0.042 ） in group C. The incidence rate of pain was lowest in group C （ x^2 = 16.415, P= 0.025 ） and rate of successful intubation was highest （ x^2= 16.415, P= 0.042 ）. Conclusions The optimal timing for placement of indwelling catheter in patients receiving combined spinal and epidural anesthesia is more than 5 minutes after CSEA.