腰硬联合麻醉不同入路在剖宫产术中的应用

Clinical observation of combined spinal-epidural anesthesia of different approaches applied in cesarean section

目的研究腰硬联合麻醉(CSEA)正中入路穿刺法与侧入路穿刺法在剖宫产术应用的穿刺成功率及腰痛发生率。方法选择无腰背痛病史,无脊柱畸形,无椎管内麻醉禁忌证的剖宫产产妇300例,随机分成两组:正中入路组(A组)和侧入路组(B组),比较两组一次穿刺成功率,二次穿刺成功率,穿刺时易感发生率,硬外管误入血管发生率,麻醉效果,术后5天腰痛发生率,术后半年电话回访腰痛发生率。结果 A、B两组一次穿刺成功率分别为76%和95%,二次以内穿刺成功率分别为88%和100%,穿刺时易感发生率分别为8.67%和8.00%,硬外管误入血管发生率分别为11.33%和12.67%,麻醉效果无差异,术后5天腰痛发生率为30.67%和6.67%;术后半年电话回访腰痛发生率14.19%和1.33%。结论 CSEA侧入穿刺法在剖宫产的麻醉中优于传统的正中入路穿刺法,值得推广。

Objective To study the success rate of puncture and the occurrence of low back pain in different approaches of CSEA applied in cesarean section. Methods 300 cases of cesarean section patients were randomly divided into two groups by different approaches of CSEA: median approach group and lateral approach group. Success rate of puncture, occurrence of low back pain and other relevant anaesthetic measures were evaluated. Results Lateral approach of CSEA had more higher success rate of puncture and lower occurrence of low back pain than lateral approach. Conclusion Lateral approach of CSEA has more advantages than the traditional median approach and is worthy to be promoted.