改良25G针蛛网膜下腔阻滞麻醉用于混合痔手术的临床应用

Clinical application of modified subarachnoid space block anesthesia using 25G needle in mixed hemorrhoid surgery

目的：评估改良25G针蛛网膜下腔阻滞在混合痔术中的临床应用.方法：选择70例ASA分级Ⅰ或Ⅱ级的患者,将其随机分为观察组（n=35）和对照组（n=35）.观察组采用改良25G针穿刺技术行蛛网膜下腔阻滞麻醉,对照组采用针内针技术行腰-硬联合阻滞麻醉.均选取L3~4间隙行穿刺,蛛网膜下腔注入局麻药（0.75%左旋布比卡因）9 mg.记录麻醉操作时间、麻醉起效时间及恢复时间,术后头痛等不良反应.结果：观察组麻醉操作时间较对照组短,穿刺点渗血较对照组少,差异均有统计学意义（P〈0.05）;观察组麻醉效果和对照组接近,均满足手术要求.观察组发生头痛等不良反应例数少于对照组,但差异无统计学意义（P〉0.05）.结论：改良25G针蛛网膜下腔阻滞麻醉效果确切,且损伤小,不良反应少,恢复快速,在混合痔手术的麻醉中具有优势.

AIM： To evaluate the clinical application of modified subarachnoid space block anesthesia using 25 G needle in mixed hemorrhoid surgery. METHODS： A total of 70 patients staged as Ⅰ or Ⅱ according to ASA were selected and randomly divided into two groups. Those underwent modified subarachnoid space block anesthesia using 25 G needle were included in observation group（ n = 35）,and those underwent combined spinal-epidural anesthesia were included in control group（ n = 35）. For all patients,puncture was performed at intervertebral space of L3-4,and 9 mg local anesthetic levobupivacaine of 0. 75% was injected into subarachnoid space. The operation, onset, and recovery times of anesthesia,as well as adverse reactions such as headache were recorded. RESULTS： Compared with the control group,the operation time was shorter,and the bleeding at the puncture site of the observation group was less（ P〈0. 05）. The effects of anesthesia of the two groups were about the same,and they both met the requirement of the surgery. The adverse reactions such as headache in observation group were less than those in the control group,with no statistically significant difference（ P〉0. 05）.CONCLUSION： During surgery for subarachnoid block, the modified subarachnoid space block anesthesia using 25 G needle has definite effect. It causes less injury and ensures rapid recovery.