两点法腰硬联合麻醉在上腹部手术中的应用研究

Applied research of two-point combined spinal-epidural anesthesia in upper abdominal surgery

目的探讨两点法腰硬联合麻醉(two-point CSEA)用于上腹部手术的可行性。方法上腹部手术126例按住院单双号分为two-point CSEA组(n=69)和硬膜外组(EA组,n=57)。EA组于T8-9间隙行硬膜外腔穿刺置管,经导管给2%利多卡因,使阻滞平面达T4。two-point CSEA组于T7-8间隙行硬膜外腔穿刺置管,经管给2%利多卡因,于L2-3间隙行腰麻,注入复合布比卡因溶液3 ml。使阻滞平面达T4,以计分法评价肌松、牵拉反应以及麻醉效果。结果两组手术时间无统计学差异(P>0.05),two-point CSEA组阻滞范围显著大于EA组(P<0.01),镇痛效果、肌松程度以及牵拉反应抑制也显著好于EA组(P<0.01),而局麻药用量显著性少于EA组(P<0.01)。结论 two-point CSEA可有效安全地用于上腹部手术。

Objective To investigate the efficacy of combined spinal-epidural anesthesia（CSEA） in upper abdominal surgery.Mathods A total of 126 patients undergoing upper abdominal surgery were divided into two-point CSEA group（n =69）and epidural group （EA group,n =57）.The epidural anesthesia was punctured at T8-9 space and resulted in the block level of T4 with 2％ lidocaine in EA group.The epidural anesthesia was performed at T7-8 space with 2％ lidocaine and spinal anesthesia was done at L2-3 space with bupivacaine solution 3 ml,and reached the block level of T4 in two-point CSEA group.The muscle relaxation,stretch reaction and the anesthetic effects were evaluated with scoring method.Results The block range was significantly greater in two-point CSEA group than in EA group（P ＜0.01）,the anesthetic effect was better（P ＜0.01）,and the dosage of local anesthesia was significantly lower（P ＜0.01）.The operation time was not significantly different between two groups （P ＞ 0.05）.Conclusion Two-point CSEA is effective and safe for the upper abdominal surgery.