硬膜外置管前注入0.9%氯化钠溶液或1%利多卡因预充液对腰硬联合麻醉下剖宫产术产妇麻醉效果及置管误入血管的影响分析

Analysis of the effect of injecting 0.9%sodium chloride solution or 1%lidocaine priming fluid on the anesthesia effect of cesarean section under combined spinalepidural anesthesia and the effect of intubation into blood vessels before epidural catheter placement

目的探究硬膜外置管前注入0.9%氯化钠溶液或1%利多卡因预充液对硬膜联合麻醉下剖宫产术产妇麻醉效果及置管误入血管的影响。方法选取2019年1月至2020年1月于本院择期行硬膜联合麻醉下剖宫产术的100名产妇作为研究对象,随机分为A组(n=34)、B组(n=33)、C组(n=33)。A组在硬膜外置管前给予1%利多卡因预充液,B组在硬膜外置管前给予0.9%氯化钠溶液,C组则直接置入硬膜外导管。比较3组给药前后血流动力学指标平均动脉压(MAP)、心率(HR)、置管入血率及置管遇阻情况。结果T0时,3组HR、MAP水平比较差异无统计学意义;T_(1)、T_(2)时,3组MAP水平均低于T_(0)时,HR水平均高于T_(0)时(P<0.05),但组间比较差异无统计学意义。A组、B组置管入血率及置管遇阻率均明显低于C组,差异有统计学意义(P<0.05),A组与B组置管入血率及置管遇阻率比较差异无统计学意义。结论剖宫产手术行硬膜外阻滞置管前注入5 ml 0.9%氯化钠溶液或利多卡因预冲液不仅可降低置管入血率,使置管顺畅,且对产妇给药后各时段平均动脉压和心率影响较小,可预防导管置入血管。

Objective To investigate the effect of injecting 0.9%sodium chloride solution or 1%lidocaine priming fluid on the anesthesia effect of cesarean section under combined spinal-epidural anesthesia and the effect of intubation into blood vessels before epidural catheter placement.Methods 100 puerperae who underwent elective cesarean section under combined spinal-epidural anesthesia in our hospital from January 2019 to January 2020 were selected as the research subjects and they were randomly divided into group A(n=34),group B(n=33),and group C(n=33).Group A was given 1%lidocaine prefill before epidural catheterization,and group B was given 0.9%sodium chloride solution before epidural catheterization,and group C was directly placed into epidural catheter,the hemodynamic indexes of mean arterial pressure(MAP),heart rate(HR),implanted blood vessels and catheter obstruction among the three groups before and after administration were compared.Results At T0,there was no significant difference in HR and MAP levels among the three groups;at T_(1) and T_(2),the MAP levels of the three groups were lower than those at T_(0),and HR were higher than those at T0(P<0.05),but there was no significant difference among the three groups.The rate of catheterization and pipe setting in group A and group B were significantly lower than those in group C,and the difference was statistically significant(P<0.05).There was no significant difference between group A and group B in the rate of catheterization and the pipe setting.Conclusion Injecting 5 ml of 0.9%sodium chloride solution or lidocaine priming fluid into the pre-filling solution before cesarean section surgery can not only reduce resistance rate,but also smooth th tube,the effect of mean arterial pressure and heart rate in each time period is small,which can prevent catheter placement in blood vessels.