硬膜外腔%图像,压力%液相,回流%监测
硬膜外腔%圖像,壓力%液相,迴流%鑑測
경막외강%도상,압력%액상,회류%감측
Epidural space%Graph,dynamic pressure%Liquid,reflow%Monitor
目的 探讨压力图像与回流液相双指征法辅助硬膜外麻醉定位与监测的准确性与可行性.方法 择期硬膜外麻醉患者1 200例,ASA Ⅰ～Ⅲ级,年龄、体重、性别不限.根据硬膜外穿刺节段分为6组(每组200例):颈组(C4～5/C5～6/C6～7,C组),胸Ⅰ组(T3～4/T4～5,T1组),胸Ⅱ组(T8～9/T9～10,T2组),胸Ⅲ组(T10～11/T11～12,T3组),腰Ⅰ组(T12～L1/L1～2,L1组),腰Ⅱ组(L2～3/L3～4,L2组).所有患者均采用直入法进针,固定至脊上韧带后,退出针芯,穿刺针经三通与ICP传感器连接,进针的同时观察不同层次压力数值与图像变化,当图像显示直线返折,继而曲线波形出现且数值形成落差时,经三通注入3 ml气泡盐水无压缩,即可确认进入硬膜外腔,头向置管15 cm,退针后留管3 cm,固定导管平卧,导管末端连接装有盐水的玻璃注射器.全程根据压力动态图像显示导管在硬膜外腔,观察回流液性状(-清；+微红；++显红；+++深红；++++血性)5 min,回流液性状为(+++)以下,给予试验量、维持量完成手术.观察记录麻醉全程回流液性状.记录到达黄韧带(T0)、硬膜外腔(T1)、注药动态平衡后(T2)的压力值.观察并记录分次注药后压力图像变化及阻滞效果,各类副作用.结果 所有患者均未出现神经、脊髓损伤等并发症.突破黄韧带前,压力数值呈急剧上升像,进针至黄韧带,压力波形为直线,压力数值为(82±26) mmHg(1 mmHg=0.133 kPa).突破黄韧带进入硬膜外腔,压力图像呈特异性直线返折,继而出现正弦波形,压力数值明显降低到(7±12) mm Hg.与T0比较,各组T1、T2均有降低(P＜0.05).与T1比较,各组T2均升高(P＜0.05).结论 压力图像与回流液相双指征法辅助硬膜外麻醉准确可靠,简便易行,可常规用于各年龄组、各节段硬膜外麻醉.
目的 探討壓力圖像與迴流液相雙指徵法輔助硬膜外痳醉定位與鑑測的準確性與可行性.方法 擇期硬膜外痳醉患者1 200例,ASA Ⅰ～Ⅲ級,年齡、體重、性彆不限.根據硬膜外穿刺節段分為6組(每組200例):頸組(C4～5/C5～6/C6～7,C組),胸Ⅰ組(T3～4/T4～5,T1組),胸Ⅱ組(T8～9/T9～10,T2組),胸Ⅲ組(T10～11/T11～12,T3組),腰Ⅰ組(T12～L1/L1～2,L1組),腰Ⅱ組(L2～3/L3～4,L2組).所有患者均採用直入法進針,固定至脊上韌帶後,退齣針芯,穿刺針經三通與ICP傳感器連接,進針的同時觀察不同層次壓力數值與圖像變化,噹圖像顯示直線返摺,繼而麯線波形齣現且數值形成落差時,經三通註入3 ml氣泡鹽水無壓縮,即可確認進入硬膜外腔,頭嚮置管15 cm,退針後留管3 cm,固定導管平臥,導管末耑連接裝有鹽水的玻璃註射器.全程根據壓力動態圖像顯示導管在硬膜外腔,觀察迴流液性狀(-清；+微紅；++顯紅；+++深紅；++++血性)5 min,迴流液性狀為(+++)以下,給予試驗量、維持量完成手術.觀察記錄痳醉全程迴流液性狀.記錄到達黃韌帶(T0)、硬膜外腔(T1)、註藥動態平衡後(T2)的壓力值.觀察併記錄分次註藥後壓力圖像變化及阻滯效果,各類副作用.結果 所有患者均未齣現神經、脊髓損傷等併髮癥.突破黃韌帶前,壓力數值呈急劇上升像,進針至黃韌帶,壓力波形為直線,壓力數值為(82±26) mmHg(1 mmHg=0.133 kPa).突破黃韌帶進入硬膜外腔,壓力圖像呈特異性直線返摺,繼而齣現正絃波形,壓力數值明顯降低到(7±12) mm Hg.與T0比較,各組T1、T2均有降低(P＜0.05).與T1比較,各組T2均升高(P＜0.05).結論 壓力圖像與迴流液相雙指徵法輔助硬膜外痳醉準確可靠,簡便易行,可常規用于各年齡組、各節段硬膜外痳醉.
목적 탐토압력도상여회류액상쌍지정법보조경막외마취정위여감측적준학성여가행성.방법 택기경막외마취환자1 200례,ASA Ⅰ～Ⅲ급,년령、체중、성별불한.근거경막외천자절단분위6조(매조200례):경조(C4～5/C5～6/C6～7,C조),흉Ⅰ조(T3～4/T4～5,T1조),흉Ⅱ조(T8～9/T9～10,T2조),흉Ⅲ조(T10～11/T11～12,T3조),요Ⅰ조(T12～L1/L1～2,L1조),요Ⅱ조(L2～3/L3～4,L2조).소유환자균채용직입법진침,고정지척상인대후,퇴출침심,천자침경삼통여ICP전감기련접,진침적동시관찰불동층차압력수치여도상변화,당도상현시직선반절,계이곡선파형출현차수치형성락차시,경삼통주입3 ml기포염수무압축,즉가학인진입경막외강,두향치관15 cm,퇴침후류관3 cm,고정도관평와,도관말단련접장유염수적파리주사기.전정근거압력동태도상현시도관재경막외강,관찰회류액성상(-청；+미홍；++현홍；+++심홍；++++혈성)5 min,회류액성상위(+++)이하,급여시험량、유지량완성수술.관찰기록마취전정회류액성상.기록도체황인대(T0)、경막외강(T1)、주약동태평형후(T2)적압력치.관찰병기록분차주약후압력도상변화급조체효과,각류부작용.결과 소유환자균미출현신경、척수손상등병발증.돌파황인대전,압력수치정급극상승상,진침지황인대,압력파형위직선,압력수치위(82±26) mmHg(1 mmHg=0.133 kPa).돌파황인대진입경막외강,압력도상정특이성직선반절,계이출현정현파형,압력수치명현강저도(7±12) mm Hg.여T0비교,각조T1、T2균유강저(P＜0.05).여T1비교,각조T2균승고(P＜0.05).결론 압력도상여회류액상쌍지정법보조경막외마취준학가고,간편역행,가상규용우각년령조、각절단경막외마취.
Objective To study the accuracy and feasibility of dynamic pressure graph and liquid reflow as double indication for epidural space orientation.Methods 1 200 A SA Ⅰ -Ⅲ patients undergone epidural anesthesia were enrolled.They were divided into 6 groups according to spinal segments of puncture site(n=200):Cervical Group(C4-5/C5-6/C6-7,Group C),Thoracic Group Ⅰ (T3-1/T4-5,Group T1),Thoracic Group Ⅱ (T8-9/T9-10,Group T2),Thoracic Group Ⅲ (T10-11/T11-12,Group T3),Lumbar GroupⅠ (T12-L1/L1-2,Group L1),Lumbar Group Ⅱ (L2-3/L3-4,Group L2).Pressure graph were being recorded continuously.Midline epidural puncture were performed in all patients.The puncture needle was fixed to supraspinous ligament and connected to the ICP transducer by a 3-way stopcock.The pressure graph was observed during puncturing.After the appearance of steep decreasing pressure line followed by a curved waveform,3 ml saline was injected through the 3-way stopcock.Successful puncture was confirmed by bubble compression test.The epidural tube was inserted 15 cm headward.After withdrawn the needle,3 cm was left in the epidural space.The end of the tube was connected to a glass syringe filled with saline.The tube position in the epidural space was proved by dynamic pressure graph.The appearance of thee refiow liquid (-clear,+weak red,++obviously red,+++deep red,++++redness)was observed for 5 min.Patients whose liquid character between --+++ were given experimental and maintenance dose for surgery.The character of the reflow liquid was observed continuously during anesthesia.The time points were recorded when the needle reached the ligament flavum (T0) and the epidural space (T1),and when a dynamic pressure balance (T2) was reached.The dynamic pressure graph,the effect of the blockage after each injection,and all complications were observed and recorded respectively.Results No complications were observed during the study.Pressure numerical values suddenly increased before the breakthrough of the ligament flavum[ zoomed to(82.00±25.61 ) mm Hg( 1 mm Hg=0.133 kPa)].The pressure graph remained a straight line when the needle was inside the ligament.After the needle reached the epidural space,it showed a specific graph with reflexed linear and a sine-shaped waveform afterwards.A sudden drop in the pressure to (6.51±11.59) mm Hg was found.The pressure at T1 and T2 were decreased compared to that at T0 (P＜0.05).Meanwhile,the pressure at T2 was higher than that at T1 (P＜0.05).Conclusion Epidural dynamic pressure graph and liquid reflow as double indication for epidural space orientation is reliable and accurate.It is simple and convenient in epidural anesthesia in all age groups regardless of spinal segments.
