CAJ | 학술논문

目的：观察两种材质的硬膜外导管置入长度对导管置入血管及导致患者感觉异常的并发症的影响。方法选择拟行腰椎-硬膜外联合阻滞的剖宫产手术的产妇240例，年龄23～36岁，体重55～75 k g，A S A分级Ⅰ或Ⅱ级。足月妊娠且无妊娠期并发症，无椎管内麻醉禁忌证。采用随机数字表法，将其随机分为4组，每组60例，普通聚氯乙烯硬膜外导管组(A)、进口钢丝加强型硬膜外导管组(Arrow公司，美国)(B组)，其中A组又分为A1组(硬膜外腔导管置入长度3cm)，A2组(硬膜外腔导管置入长度10cm)；B组又分为B1组(硬膜外腔导管置入长度3cm)，B2组(硬膜外腔导管置入长度10cm)。于侧卧位下行L2-3间隙硬膜外腔穿刺术，头向置入硬膜外导管。后连接注射器回抽，各组产妇如回抽血液通畅说明发生导管置入血管的并发症，置管过程中如产妇自诉有腰腿部、背部等触电般发麻疼痛等刺激症状视为感觉异常。结果与A1组比较A2组置入血管及置管时感觉异常的发生率差异无统计学意义(P>0.05)。与A1组、A2组比较B1、B2组置入血管及置管时感觉异常的发生率明显降低，差异有统计学意义(P<0.05)。B2组与B1组比较差异无统计学意义(P>0.05)。结论在剖宫产硬膜外麻醉中，硬膜外导管置入血管及引起感觉异常的不良并发症方面，导管置入长度不是主要原因，但进口钢丝加强型硬膜外导管在减少硬膜外导管置入血管及引起感觉异常方面优于普通硬膜外导管。
목적：관찰량충재질적경막외도관치입장도대도관치입혈관급도치환자감각이상적병발증적영향。방법선택의행요추-경막외연합조체적부궁산수술적산부240례，년령23～36세，체중55～75 k g，A S A분급Ⅰ혹Ⅱ급。족월임신차무임신기병발증，무추관내마취금기증。채용수궤수자표법，장기수궤분위4조，매조60례，보통취록을희경막외도관조(A)、진구강사가강형경막외도관조(Arrow공사，미국)(B조)，기중A조우분위A1조(경막외강도관치입장도3cm)，A2조(경막외강도관치입장도10cm)；B조우분위B1조(경막외강도관치입장도3cm)，B2조(경막외강도관치입장도10cm)。우측와위하행L2-3간극경막외강천자술，두향치입경막외도관。후련접주사기회추，각조산부여회추혈액통창설명발생도관치입혈관적병발증，치관과정중여산부자소유요퇴부、배부등촉전반발마동통등자격증상시위감각이상。결과여A1조비교A2조치입혈관급치관시감각이상적발생솔차이무통계학의의(P>0.05)。여A1조、A2조비교B1、B2조치입혈관급치관시감각이상적발생솔명현강저，차이유통계학의의(P<0.05)。B2조여B1조비교차이무통계학의의(P>0.05)。결론재부궁산경막외마취중，경막외도관치입혈관급인기감각이상적불량병발증방면，도관치입장도불시주요원인，단진구강사가강형경막외도관재감소경막외도관치입혈관급인기감각이상방면우우보통경막외도관。
Objective To observe the impact of two different kinds of epidural catheters in length for cesarean delivery under CSEA in intravascular placement and paresthesia. Methods 240 parturients of ASA I or 11,aged 23-36 yr,weighing 55-75 kg,scheduled for cesarean delivery under combined spinal-epidural anesthesia. Ful-term pregnancy and no pregnancy complications, no anesthesia intra-spinal canal contraindicated. were randomly divided into 4 groups(n=60 each):polyvinyl chloride epidural catheter group(group A),imported wire,reinforced epidural catheter group(Arrow Company, the US)(group B).Divide group A into group A1(Epidural catheter placement length is 3 cm), group A2(Epidural catheter placement length is 10 cm). Divide group B into group B1(Epidural catheter placement length is 3 cm), group B2(Epidural catheter placement length is 10 cm).The epidural puncture was performed at L2-3 interspace. Place the epidural catheters to the head side , connect the syringe to smok,if withdrawing blood flow smoothly ,it means the vascular catheterization complications occurred.If parturient said she feels electric shock, such as pins and needles stimulate symptoms on the back or in the leg or the feet ,this means paresthesia. Results Compared with A1 group, no significant change of intravascular placement and paresthesia was found in A2 group(P>0.05). Compared with A1 and A2 group, intravascular placement and paresthesia are found significant smal er in B1 and B2 group(P<0.05). Compared with B1,no no significant difference in B2(P>0.05). Conclusion The adverse events of intravascular placement and paresthesia during cesarean delivery under CSEA,the length of the cannulation is not the main reason,but to decrease the adverse events of intravascular placement and paresthesia , the imported wire,reinforced epidural catheter is better than the polyvinyl chloride epidural catheter.