柔性钢丝加强型导管在硬膜外腔不同预置深度变向情况探讨

Discussion on the retraction of flexible wire-reinforced catheter with different preset depths in epidural space

目的探讨柔性钢丝加强型硬膜外导管不同预置深度在硬膜外腔走行情况。方法选择择期腰硬联合麻醉下行经皮肾镜碎石取石手术患者240例,ASA分级Ⅰ-Ⅱ,年龄18~54岁,身高152~176 cm,体质量46~77 kg,随机数字表法均分为3组。各组行腰硬联合麻醉(腰麻选择L3/4间隙,硬膜外选择T11/12间隙),选择柔性钢丝加强型硬膜外导管头端置管,A组置入3 cm,B组置入4 cm,C组置入5 cm。观察记录各组置入顺畅度、神经刺激症状以及在X线显影下导管实际置入深度、游走形状并进行统计学处理。结果A组置管顺畅度高于B和C组,但差异无统计学意义(P>0.05);A组置管时神经刺激发生率低于B和C组(P<0.05)。各组患者硬膜外导管在X线显影下均呈异常走位,A组患者偏移比例33.75%;B组患者偏移比例52.5%,折返比例2.5%;C组患者偏移比例45%,折返比例15%,打圈比例22.5%,组间比较差异有统计学意义(P<0.05);置管实际误差深度,A组明显低于B和C组(P<0.05),B和C组差异无统计学意义(P>0.05)。结论柔性钢丝加强型硬膜外导管置管顺畅,但实际硬膜外腔游走变异较大,置入深度越深,神经刺激比例增大且导管折返、打圈现象加重,实际与预置深度偏差亦较大,临床硬膜外补充给药时值得参考。

Objective To investigate the retraction of flexible wire-reinforced catheter with different preset depths in epidural space.Methods A total of 240 patients(aged 18-54 years,ASAⅠ~Ⅱ,height 152~176 cm,weight 46~77 kg)undergoing PCNL were randomly assigned into 3 groups.Combined epidural anesthesia was performed in each group(L3/4 was selected for SA and T11/12 was selected for EA).Flexible wire reinforced epidural catheter was inserted into the epidural cavity for 3 cm in group A,4 cm in group B,and 5 cm in group C.The complications of catheterization and migration shape of the catheter were observed and recorded.Results The catheterization in group A was better than that of group B and C,but the difference was not statistically significant(P>0.05).The nerve stimulation in group A was less serious than that in group B and C(P<0.05).In each group,the catheters showed obvious abnormal position under X-ray fluoroscopy.The deviation proportion of group A was33.75%.In group B,the deviation ratio was 52.5%and the return ratio was 2.5%.In group C,the deviation proportion was 45%,the return proportion was 15%and the swerved proportion was 22.5%.There were statistically significant differences between each two groups(P<0.05).The actual D-value depth of catheterization was significantly lower in group A than in group B,C(P<0.05),but the difference between group B and C was not statistically significant(P>0.05).Conclusion The flexible wire reinforced epidural catheter was placed smoothly,but the actual epidural cavity migration varied greatly.The deeper the insertion depth was,the higher nerve stimulation,the worse catheter retraction and circling happened.The actual D-value depth were deviated greatly.Therefore,it is not recommended in the administration of anesthesia.