9号皮针引导25G腰穿针腰麻临床应用

Clinical application of 25G fine needle aspiration for lumbar anesthesia guided by 9th percutaneous needle

目的探讨9号皮针引导下25G细针腰麻穿刺的可行性。方法选择下肢、会阴及盆腹腔手术患者60例,随机分成腰硬联合麻醉(对照组)和皮针引导细针组(实验组)。观察细腰针脊麻穿刺成功率、黄韧带和硬脊膜突破感知率、腰穿后脑脊液流出率及术后穿刺点和腰痛发生率。结果脊麻注药完成以后,两组感觉阻滞平面、T10感觉阻滞起效时间和运动神经阻滞起效时间比较,无显著性差异(P>0.05)。实验组穿刺时间(71.18±13.2)s,长于对照组的(55.10±15.8)s,有显著性差异(P<0.01)。实验组细针腰麻成功率93.3%优于联合麻醉组的76.7%;实验组腰穿成功后脑脊液流出通畅,优于联合麻醉组(P<0.05);术后穿刺点和腰痛发生率17.9%低于联合麻醉组的36.7%;两组细腰针突破硬脊膜时均有确切的纸质破裂感或阻力落空感,无显著差异(P>0.05)。结论 9号皮针引导25G细针腰穿可以确切感知突破硬脊膜,脑脊液流出通畅,腰麻麻醉效果确切,减少术后穿刺点及腰痛发生,相对于联合麻醉,并不增加穿刺过程中引起的神经损伤,适用于年轻患者的下肢、会阴及盆腹腔手术麻醉。

Objective To explore the feasibility of 25G fine needle aspiration for lumbar anesthesia guided by 9th percutaneous needle. Methods Sixty cases underwent lower limbs, perineum and abdominopelvie surgery were selected and randomly divided into the control group underwent combined spinal-epidural anesthesia and the experimental group underwent fine needle aspiration for lumbar anesthesia guided by the pereutaneous needle. The success rate of spinal anesthesia with fine needle aspiration, breakthrough perception rate of yellow ligaments and dura, cerebrospinal fluid outflow rate after the lumbar puncture and incidence of puncture site pain and lumbar pain after the surgery were observed. Results After the completion of spinal anesthesia injection, the differences were not significant in plane of sensation block, onset time of T10 sensation block and motor block between the two groups （P〉0.05）. The puncture time in the experimental group （71.18±13.2）（20-165）s was longer than that in the control group （55.10±15.8）s, the difference was significant （P〈0.01）. The success rate of lumbar anesthesia with fine needle in the experimental group （93.3%） was better than that in the control group （76.7%）; The cerebrospinal fluid in the experimental group out- flowed smoothly after the successful lumbar puncture, and the cerebrospinal fluid outflow rate after the lumbar puncture in the experimental group was better than that in the control group （P〈0.05）; The incidence of puncture site pain and lumbar pain after the surgery in the experimental group （17.9%） was lower than that in the control group （36.7%）; There were the exact senses of paper rupture or resistance disappearance when the fine needles of two groups broke through the dura, the difference was not significant （P〉0.05）. Conclusion The 25G fine needle aspiration for lumbar anesthesia guided by 9th percutaneous needle has the exact sense of the breakthrough into the dura, makes the cerebrospinal fluid outflow smoothly, has the exact effect of lumbar anesthesia, reduces the incidence of puncture site pain and lumbar pain after the surgery, and compares with the combined spinal-epidural anesthesia, it＇s nerve damages does not be increased during the puncturing process, and it is more suitable for young patients with lower limbs, per- ineum and abdominopelvic surgery anesthesia.