改良旁正中入路细针和传统针内针穿刺蛛网膜下腔麻醉在剖宫产手术中的应用

Application of subarachnoid anesthesia with improved method of fine needle through paramedian approach and traditional needle in cesarean section

目的:观察改良细针腰麻法与传统针内针腰麻法在剖宫产手术中应用的优劣。方法:按随机数字表法将90例拟行剖宫产手术患者分为传统针内针正中入路组(TM组)、改良25G细针正中入路组(IM组)、改良25G细针旁正中入路组(IPM组),每组30例。观察穿刺次数、穿刺时间、穿刺时针尖刺中骨骼次数、麻醉前及麻醉后的心率和血压、术后24 h及术后6 d头痛、腰痛发生率。结果:IM组及IPM组相较于TM组穿刺次数及穿刺时针尖刺中骨骼次数更少(均P<0.05),穿刺时间更短(P<0.05),术后腰痛的发生率更低(P<0.05)。其他指标3组均无统计学差异(均P>0.05)。结论:改良细针腰麻法相较于传统针内针腰麻法在剖宫产手术中穿刺时间短、穿刺时针尖刺中骨骼次数少,术后腰痛发生率低。

Objective:To compare the advantages and disadvantages of the improved fine needle paramedian approach and the traditional needle approach for spinal anesthesia in the cesarean section.Methods:According to the method of random number table,90 cases of cesarean section were divided into 3 groups:a traditional needle median approach group(TM group),an improved 25 G fine needle median approach group(IM group),and an improved 25 G fine needle paramedian approach group(IPM group),30 cases in each group,respectively.The number of punctures,the puncture time,the number of puncturing the bones,the heart rate and blood pressure before and after anesthesia,and the incidence of headache or lumbago 24 h and 6 days after the operation were observed.Results:Compared with the TM group,IM group and IPM group had fewer puncture times and bone puncturing(P<0.05),shorter puncture time(P<0.05),and lower incidence of postoperative lumbago(P<0.05).There was no significant difference in other indexes among the 3 groups(P>0.05).Conclusion:Compared with the traditional method,the improved method has fewer puncture times,shorter puncture time,fewer bone puncturings,and lower incidence of postoperative lumbago.