脊髓麻醉联合硬膜外麻醉行肾移植术时合理脊髓麻醉平面的探讨

Upper analgesia level of subarachnoid block is related to efficiency of combining spinal and epidural anesthesia in renal transplantation

目的 :探讨脊髓麻醉联合硬膜外麻醉行肾移植术时脊髓麻醉平面与麻醉效果的关系。 方法 :90名肾移植患者随机分为 3组 ,均采用硬膜外麻醉联合脊髓麻醉。 A组 (n=30 )脊髓麻醉平面调至 T3- 4,B组 (n=30 )为 T5- 7,C组 (n=30 )为 T8以下。观察和比较各组术中自脊髓麻醉开始至硬膜外麻醉开始用药时间和用药量、血压波动幅度和多巴胺用量以及术中不良反应的发生情况。结果 :自脊髓麻醉开始至硬膜外开始用药的时间 A组 >B组 >C组 (P<0 .0 5 )。硬膜外用药总量 A组 <B组 <C组 (P<0 .0 5 )。 B组及 C组血压的波动幅度和多巴胺用量明显小于 A组 (P<0 .0 5 )。而术中发生恶心、呕吐及肌震颤的例数均相对较少的仅有 B组。 结论 :肾移植行脊髓麻醉联合硬膜外麻醉时 ,脊髓麻醉平面调整至 T5- 7,既能达到较好的麻醉效果 ,又能减少不良反应的发生。

Objective: To investigate the relationship between the upper analgesia level of subarachnoid block and the efficiency of combining spinal and epidural anesthesia in renal transplantation. Methods: Ninety patients undergoing renal transplantation were randomly divided into 3 groups. The upper analgesia level of subarachnoid block was T 3 4 in group A( n =30), T 5 7 in group B( n =30) and lower than T 8 in group C( n =30). When epidural drug was needed,the total amount of drug used in epidural space, the changes of blood pressure, the amount of dopamine used and the incidence of adverse effects during operation were observed. Results: The period from the beginning of spinal anesthesia to drug start to be used in epidural space:group A>group B>group C( P <0.05).And the total amount of drug used in epidural space: group A<group B< group C( P <0.05).The blood pressure of group B and C changed lightly, and less amount of dopamine was used in group B and C than in group A( P <0.05). Nausea (or vomit) and trembling were scarcely found only in group B. Conclusion: When combining spinal and epidural anesthesia in renal transplantation, the upper analgesia level of subarachnoid block to T 5 7 can result in a favorable anesthesia effect and bring about less adverse effects.