CAJ | 학술논문

目的探讨硬膜外注气对脊椎-硬膜外联合阻滞时腰穿的影响.方法拟在脊椎-硬膜外联合阻滞下行剖宫产术的足月单胎妊娠患者210例,ASA分级Ⅰ或Ⅱ级,年龄20～42岁,身高152～170 cm,体重57～82 kg,采用随机数字表法,将患者随机分为3组(n=70):悬滴法组(Ⅰ组)、少量注气组(Ⅱ组)和大量注气组(Ⅲ组).Ⅰ组以悬滴法验证硬膜外腔,Ⅱ组和Ⅲ组以注气试验验证硬膜外腔.Ⅱ组注气量以能感觉到阻力消失为准,Ⅲ组注气量为4 ml.置入腰穿针后见脑脊液回流则为腰穿成功.腰穿失败则改行硬膜外麻醉.记录腰穿成功情况、腰穿失败但硬膜外穿刺成功情况及不良反应发生情况.结果 Ⅰ组、Ⅱ组和Ⅲ组腰穿成功率分别为91%、93%和79%,Ⅰ组和Ⅱ组高于Ⅲ组(P<0.05),Ⅰ组和Ⅱ组间差异无统计学意义(P>0.05).所有腰穿失败患者均取得了双侧躯体节段性痛觉消失的硬膜外麻醉效果;所有腰穿成功患者也均取得了预期的麻醉效果.均未见严重不良反应发生.结论硬膜外注气与脊椎-硬膜外联合阻滞时腰穿成功有关,大量注气可降低腰穿成功机率.
목적 탐토경막외주기대척추-경막외연합조체시요천적영향.방법 의재척추-경막외연합조체하행부궁산술적족월단태임신환자210례,ASA분급Ⅰ혹Ⅱ급,년령20～42세,신고152～170 cm,체중57～82 kg,채용수궤수자표법,장환자수궤분위3조(n=70):현적법조(Ⅰ조)、소량주기조(Ⅱ조)화대량주기조(Ⅲ조).Ⅰ조이현적법험증경막외강,Ⅱ조화Ⅲ조이주기시험험증경막외강.Ⅱ조주기량이능감각도조력소실위준,Ⅲ조주기량위4 ml.치입요천침후견뇌척액회류칙위요천성공.요천실패칙개행경막외마취.기록요천성공정황、요천실패단경막외천자성공정황급불량반응발생정황.결과 Ⅰ조、Ⅱ조화Ⅲ조요천성공솔분별위91%、93%화79%,Ⅰ조화Ⅱ조고우Ⅲ조(P<0.05),Ⅰ조화Ⅱ조간차이무통계학의의(P>0.05).소유요천실패환자균취득료쌍측구체절단성통각소실적경막외마취효과;소유요천성공환자야균취득료예기적마취효과.균미견엄중불량반응발생.결론 경막외주기여척추-경막외연합조체시요천성공유관,대량주기가강저요천성공궤솔.
Objective To investigate the effect of injection of air into the epidural space on the subarachnoid puncture during the combined spinal-epidural anesthesia (CSEA) .Methods Two hundred and ten ASA Ⅰ or Ⅱ parturients who were at full term with a singleton fetus, aged 20-42 yr, weighing 57-82 kg (height 152-170cm) , undergoing cesarean section under CSEA, were randomly divided into 3 groups ( n = 70 each) : hanging drop technique group (group Ⅰ ) and injection of small volume of air group (group Ⅱ ) and injection of large volume of air group ( group Ⅲ ) . The epidural space was indentified using hanging drop technique in group Ⅰ and using loss of resistance to air technique in Ⅱ and Ⅲ groups. Injection of air was stopped as soon as the clear loss of resistance identified the epidural space in group Ⅱ , whereas all 4 ml of air was injected in group Ⅲ . After the epidural space was confirmed at L3,4 interspace, a 25-gauge spinal needle protruding 14 mm beyond the 18-gauge epidural needle was introduced through the epidural needle. Subarachnoid placement was confirmed by backflow of cerebrospinal fluid (CSF) . If no backflow of CSF was observed, the spinal needle was withdrawn and an epidural catheter was inserted through the epidural needle to perform epidural anesthesia. Successful subarachnoid puncture, failures to observe backflow of CSF and adverse reactions were recorded. Results The three groups were comparable with respect to age, height, body weight and gestation weeks. The success rate of subarachnoid puncture was 91% ,93% and 79% in Ⅰ ,Ⅱ and Ⅲ groups respectively, and it was significantly higher in Ⅰ and Ⅱ groups than in group Ⅲ ( P < 0.05) . There was no significant difference in the success rate of subarachnoid puncture between Ⅰand Ⅱ groups ( P > 0.05) . Bilateral segmental analgesia presented in all cases who received only epidural anesthesia after no backflow of CSF was observed, and the expected analgesia also presented in all cases in whom back flow of CSF was observed. No adverse reactions occurred. Conclusion Injection of air into the epidural space is related to the success of subarachnoid puncture during CSEA and injection of a large volume of air lowers the success rate.