联合麻醉时硬膜外腔注药影响腰麻平面的机理探讨

Effects of epidural injecting with normal saline solution or lidocaine on spinal level during combined spinal epidural anesthesia

目的 研究硬膜外腔注射生理盐水或利多卡因对腰麻平面的影响 ,并探讨其可能的机制。方法 择期手术患者 30例 ,分为生理盐水组和利多卡因组 ,实施腰麻硬膜外联合麻醉( CSEA) ,腰麻平面固定后分别向硬膜外腔注射生理盐水或利多卡因 ,观测最高腰麻平面。结果 生理盐水与利多卡因均不同程度地扩展腰麻平面 ,注射 2 .5ml的剂量 ,腰麻平面可升高 0 .8个脊髓节段 ( P<0 .0 5) ,注射 5、10 ml可升高 1～ 1.8个脊髓节段 ( P<0 .0 1)。但注射生理盐水和利多卡因两组之间差异无统计学意义。

Objective To compare the effects of epidural injeceting with normal saline solution or lidocaine on anesthesia spinal level,and to explore the probably mechanisms.Methods Thirty patients undergoing combined spinal and epidural anesthesia for elective surgeries were randomly assigned to saline group and lidocaine group.When the spinal analgesia level was fixed normal saline or lidocaine was injected through a epidural catheter.The level of analgesia was tested after epidural injection.Results In both saline and lidocaine groups,the spinal anesthesia levels were significantly higher than basal levels.After a 2.5ml injection,the spinal anesthesia level was elevated 0.8 spinal segment ( P <0.05),and after a 5～10ml injection,1～1.8 spinal segment elevation was observed ( P <0.01).But there was no significant difference between the two groups.Conclusions The mechanism of extension of spinal anesthesia level by epidual injection of anesthetics is largely a volume effect.