CAJ | 학술논문

目的探讨不同穿刺部位对腰=硬联合阻滞麻醉对于泌尿外科手术的麻醉效果.方法选取泌尿外科手术患者108例,按数字表法随机分为两组(A组和B组各54例),两组患者均采用腰=硬联合麻醉,A组患者麻醉穿刺点为腰2～3椎间隙,B组患者麻醉穿刺点为腰3～4椎间隙,比较两组患者的麻醉前后血压、初始麻醉平面、达T6平面的时间、术中追加利多卡因药量、麻醉优良率和麻醉不良反应情况.结果 A组患者麻醉5 min血压显著低于B组(t=2.73、2.29、2.29,均P＜0.05);B组恶心呕吐、低血压、呼吸困难不良反应发生率(24.1％、14.8％、1.8％)明显低于A组不良反应发生率(44.4％、33.3％、13.0％,x2=4.97、5.07、4.86,均P＜0.05);A组初始麻醉平面明显高于B组(t=2.91,P＜0.05),A组达T6平面的时间明显短于B组(t =2.42,P＜0.05),A组术中追加利多卡因的量明显少于B组(t=2.61,P＜0.05),两组患者的麻醉优良率无显著差异(P＞0.05).结论在泌尿外科的手术麻醉过程中,选取L3-4穿刺点比L2-3穿刺点进行腰=硬联合麻醉能明显地减少恶心呕吐、低血压、呼吸困难等不良反应发生率,减轻术中痛苦;两组初始麻醉平面、达T6平面时间、追加利多卡因药量虽有显著差别,但在临床中意义不大,对麻醉优良率没有影响.
목적 탐토불동천자부위대요=경연합조체마취대우비뇨외과수술적마취효과.방법 선취비뇨외과수술환자108례,안수자표법수궤분위량조(A조화B조각54례),량조환자균채용요=경연합마취,A조환자마취천자점위요2～3추간극,B조환자마취천자점위요3～4추간극,비교량조환자적마취전후혈압、초시마취평면、체T6평면적시간、술중추가리다잡인약량、마취우량솔화마취불량반응정황.결과 A조환자마취5 min혈압현저저우B조(t=2.73、2.29、2.29,균P＜0.05);B조악심구토、저혈압、호흡곤난불량반응발생솔(24.1％、14.8％、1.8％)명현저우A조불량반응발생솔(44.4％、33.3％、13.0％,x2=4.97、5.07、4.86,균P＜0.05);A조초시마취평면명현고우B조(t=2.91,P＜0.05),A조체T6평면적시간명현단우B조(t =2.42,P＜0.05),A조술중추가리다잡인적량명현소우B조(t=2.61,P＜0.05),량조환자적마취우량솔무현저차이(P＞0.05).결론 재비뇨외과적수술마취과정중,선취L3-4천자점비L2-3천자점진행요=경연합마취능명현지감소악심구토、저혈압、호흡곤난등불량반응발생솔,감경술중통고;량조초시마취평면、체T6평면시간、추가리다잡인약량수유현저차별,단재림상중의의불대,대마취우량솔몰유영향.
Objective To explore the narcotic effects of different puncture in combined spinal-epidural block anesthesia for urological Surgery.Methods 108 cases of urologic surgery were selected.The patients were randomly divided into the two groups according to digital meter (each group had 54 cases).Both groups were treated with combined spinal-epidural anesthesia.The anesthesia puncture of group A were in lumbar intervertebral 2-3,the anesthesia puncture of Group b were in lumbar intervertebral 3-4.The respects of the two groups were observed and compared such as blood pressure before and after anesthesia,initial anesthesia plane,the time the drug arrived to the sixth thoracic vertebrae,additional lidocaine dose during the operations anesthesia quality rate and anesthesia side effects.Resuits The blood pressures of the patients of group A were significantly lower than those of group B 5 minutes after anesthesia (t =2.73,2.29,2.29,all P ＜ 0.05),the incidence of adverse reactions of Group B such as nausea,vomiting,low blood pressure,difficulty in breathing (24.1％,14.8％),was significantly lower than incidence of group A (44.4％,and 13.0％,x2 =4.97,5.07,4.86,all P ＜ 0.05) the set of initial plane of anesthesia of group a was significantly higher than that of group B (t =2.91,P ＜ 0.05),the time the drug arriving to the sixth thoracic vertebrae,of group A was significantly shorter than group B (t =2.42,P ＜ 0.05) the amounts of additional lidocaine dose of Group A during the operations were significantly less than group A (t =2.61,P ＜ 0.05).There were no significant differences in the anesthesia quality rate (P ＞ 0.05).Conclusion Selecting L3-4 puncture points in combined spinalepidural anesthesia can significantly reduce incidence of adverse reactions such as nausea,vomiting,low blood pressure and difficulty in breathing compared with selecting L2-3 puncture during urology surgery procedure.It can also reduce pain during operations.Though there are significant differences in initial level of anesthesia,the time the drug arrive to the sixth thoracic vertebrae and additional lidocaine doses,leading no effects on superior rate of anesthesia.Thus the clinical significance is not very big.