不同穿刺入路对连续性硬膜外神经阻滞效果的影响

Effect of Different Puncture Approach on Continuous Epidural Nerve Block

目的探讨减少连续性硬膜外神经阻滞失败率、提高麻醉效果的硬膜外穿刺方法。方法选择200例ASAⅠ-Ⅱ级择期下肢及中下腹连续性硬膜外神经阻滞仰卧位手术患者,随机分为直入路组（A组）和旁入路组（B组）,每组各100例。比较两组的神经阻滞效果和术后第3天下肢并发症发生情况。结果 A组阻滞完善发生率为96.0%,明显高于B组的84.0%;A组左侧神经阻滞的发生率为1.0%,明显低于B组的11.0%;A组下肢麻木和乏力的发生率分别为2.0%、1.0%,均显著低于B组的10.0%、8.0%;差异均具有统计学意义（P〈0.05）。结论在硬膜外腔穿刺的过程中确保穿刺针直入路,是提高连续性硬膜外神经阻滞效果、减少单侧阻滞发生率和下肢并发症的有效手段。

Objective To explore the method of epidural puncture on reducing the failure rate of continuous epidural nerve block and improving the anesthesia effect. Methods 200 cases of surgical patients（ASAⅠ-Ⅱ） scheduled to undergo continuous epidural nerve block in lower limbs and abdomen were randomly divided into straight approach group（group A） and side approach group（group B）, with 100 cases in each group. The nerve block effect and lower extremity complications 3 days after operation were compared between two groups.Results The incidence of complete block of group A was 96.0%, significantly higher than 84.0% of group B; the incidence of left-side nerve block of group A was 1.0%, significantly lower than 11.0% of group B; the incidence of numbness and weakness of lower limb of group A were 2.0% and 1.0% respectively, significantly lower than 10.0% and 8.0% of group B; all the difference was statistical（P〈0.05）.Conclusions The application of straight puncture approach in the process of epidural space puncture is an effective method to improve the effects of epidural anesthesia and reduce the incidence of unilateral blockage and lower extremity complications.