CAJ | 학술논문

目的比较特异性压力波形与传统针刺测试麻醉平面行硬膜外麻醉的效果,探讨特异性压力波形预测硬膜外麻醉效果的可行性. 方法拟于硬膜外麻醉下行择期胆囊切除手术患者600例,ASA Ⅰ～Ⅲ级,年龄、体重、性别不限.根据特异性压力波形辅助方法,随机数字表法随机分为两组(每组300例):试验组(T9-10,T组)和对照组(T9-10,C组).所有患者均采用正中入路进针,常规盲探突破法(阻力消失)进入硬膜外腔,两组均予以气泡盐水无压缩证实进入硬膜外腔,置管成功后C组按常规注入试验量5ml局麻药,T组连接压力监测装置,观察记录压力图像判断麻醉效果,直接予以初量10 ml～12 ml局麻药(不注试验量).C组采用针刺法确定麻醉效果及平面.记录两组穿刺结束至手术开始时间、阻滞效果、各类副作用.T组记录观察分次注药后压力波形变化. 结果两组穿刺结束至手术开始时间比较,T组明显缩短(P＜0.05).T组压力持续12 mm Hg～25 mm Hg(1 mm Hg=0.133 kPa),且为正弦波形,麻醉效果满意；压力值≥30 mm Hg,且波形为直线,麻醉效果差.压力波形特异性与麻醉效果存在相关关系. 结论在保留传统硬膜外腔穿刺优点的同时,特异性压力波形可预知硬膜外麻醉效果,在注入试验量前可明确硬膜外麻醉成功与否,提高了硬膜外麻醉精确性.
목적 비교특이성압력파형여전통침자측시마취평면행경막외마취적효과,탐토특이성압력파형예측경막외마취효과적가행성. 방법 의우경막외마취하행택기담낭절제수술환자600례,ASA Ⅰ～Ⅲ급,년령、체중、성별불한.근거특이성압력파형보조방법,수궤수자표법수궤분위량조(매조300례):시험조(T9-10,T조)화대조조(T9-10,C조).소유환자균채용정중입로진침,상규맹탐돌파법(조력소실)진입경막외강,량조균여이기포염수무압축증실진입경막외강,치관성공후C조안상규주입시험량5ml국마약,T조련접압력감측장치,관찰기록압력도상판단마취효과,직접여이초량10 ml～12 ml국마약(불주시험량).C조채용침자법학정마취효과급평면.기록량조천자결속지수술개시시간、조체효과、각류부작용.T조기록관찰분차주약후압력파형변화. 결과 량조천자결속지수술개시시간비교,T조명현축단(P＜0.05).T조압력지속12 mm Hg～25 mm Hg(1 mm Hg=0.133 kPa),차위정현파형,마취효과만의；압력치≥30 mm Hg,차파형위직선,마취효과차.압력파형특이성여마취효과존재상관관계. 결론 재보류전통경막외강천자우점적동시,특이성압력파형가예지경막외마취효과,재주입시험량전가명학경막외마취성공여부,제고료경막외마취정학성.
Objective To evaluate the effects of epidural anesthesia with application of epidural pressure dynamic graph and to investigate the feasibility of the new application. Methods 600 patients undergoing elective epidural anesthesia enrolled with ASA Ⅰ -Ⅲ,age,sex,weight unlimited.The patients were assigned into 2 groups in random:trial group (T9-10,Group T) and control group (C9-10,Group C) with 300 patients respectively.The midline approach was used in epidural space puncture.Loss of resistance to air and saline was determined when the needle reach epidural space.After securing the catheter in exact position,epidural test dose was administered by using 5 ml local anesthetic in control group epidural catheter was connected with the epidural pressure graph equipment and administered 10 ml-12 ml local anesthetic as initial dose without injection of epidural test dose in trail group.The effect of anesthesia and level of blockade were determined by needle punching on skin in control group.The pressure graph character after injecting local anesthetic was observed in trial group.The time from end of puncture to the start of the operation,the anesthesia effect and complications were recorded in all patients. Results The time from the end of epidural puncture to the start of operation in trial group was shorter when compared with control group(P＜0.05).When epidural pressure was between 12 mm Hg (1 mm Hg=0.133 kPa)and 25 mm Hg in balance,the anesthesia effect was good in trial group.While pressure was up to 30 mm Hg and the graph was in line,the anesthesia effect was bad.The specific pressure graph was correlative to the epidural anesthesia effect (P＜0.05). Conclusions Epidural pressure dynamic graph can predict the effect of epidural anesthesia before injecting the test dose of local anesthetic and does not increase the puncture time and the injury.It facilitates the accuracy of epidural anesthesia.