国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2014年
12期
1105-1108
,共4页
坐位%细针%麻醉,脊椎%剖宫产术
坐位%細針%痳醉,脊椎%剖宮產術
좌위%세침%마취,척추%부궁산술
Sitting position%Fine needle%Anesthesia,spinal%Cesarean-section
目的 探讨坐位细针腰麻在急诊剖宫产术中的临床应用效果. 方法 选择急诊剖宫产术产妇400例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,按照随机数字表法分为4组(每组100例):A组,坐位笔尖样细针腰麻组;B组,侧卧位笔尖样细针腰麻组;C组,坐位普通斜面针腰麻组;D组,侧卧位普通斜面针腰麻组.穿刺成功后注入0.5％布比卡因1.8 ml～2.2 ml(9 mg～11 mg).术毕待麻醉平面消散至T10以下后,送回病房去枕平卧6h,第1、2、3天及时随访.观察记录4组产妇的血压、脉搏血氧饱和度和心率的变化,记录腰麻穿刺次数、穿刺成功率、麻醉操作时间、穿刺开始到切皮时间、切皮到胎儿娩出时间以及术中、术后副作用. 结果 与B组和D组比较,A组和C组(即两组坐位与两组侧卧位比较)穿刺次数减少[B组(3.2±0.9)和D组(4.1±0.4),A组(1.1±0.5)和C组(1.2±0.6)]、穿刺成功率提高[B组(90％)和D组(92％),A组(100％)和C组(98％)]、穿刺时间缩短[B组(5.2±0.6) min和D组(4.1±0.9) min,A组(1.2±0.8) min和C组(2.1±0.7) min]、麻醉操作时间缩短[B组(7.1±0.5) min和D组(6.2±0.8) min,A组(3.4±0.7) min和C组(4.3±0.6) min]、从穿刺开始到切皮时间缩短[B组(15.2±6.3) min和D组(17.1±4.4) min,A组(10.4±0.5) min和C组(11.3±0.7) min](P＜0.05).与C组和D组比较,A组和B组(即两组细针与两组普通针比较)术中低血压发生率降低[C组(18％)和D组(20％),A组(8％)和B组(10％)]、恶心呕吐发生率减少[C组(10％)和D组(12％),A组(4％)和B组(5％)]、无术后头痛和腰痛发生[C组(3％)和D组(4％),A组(0)和B组(0)](P＜0.05). 结论 坐位细针腰麻,操作简便,所需时间短,穿刺次数少,成功率高,术中、术后副作用少.
目的 探討坐位細針腰痳在急診剖宮產術中的臨床應用效果. 方法 選擇急診剖宮產術產婦400例,美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級,按照隨機數字錶法分為4組(每組100例):A組,坐位筆尖樣細針腰痳組;B組,側臥位筆尖樣細針腰痳組;C組,坐位普通斜麵針腰痳組;D組,側臥位普通斜麵針腰痳組.穿刺成功後註入0.5％佈比卡因1.8 ml～2.2 ml(9 mg～11 mg).術畢待痳醉平麵消散至T10以下後,送迴病房去枕平臥6h,第1、2、3天及時隨訪.觀察記錄4組產婦的血壓、脈搏血氧飽和度和心率的變化,記錄腰痳穿刺次數、穿刺成功率、痳醉操作時間、穿刺開始到切皮時間、切皮到胎兒娩齣時間以及術中、術後副作用. 結果 與B組和D組比較,A組和C組(即兩組坐位與兩組側臥位比較)穿刺次數減少[B組(3.2±0.9)和D組(4.1±0.4),A組(1.1±0.5)和C組(1.2±0.6)]、穿刺成功率提高[B組(90％)和D組(92％),A組(100％)和C組(98％)]、穿刺時間縮短[B組(5.2±0.6) min和D組(4.1±0.9) min,A組(1.2±0.8) min和C組(2.1±0.7) min]、痳醉操作時間縮短[B組(7.1±0.5) min和D組(6.2±0.8) min,A組(3.4±0.7) min和C組(4.3±0.6) min]、從穿刺開始到切皮時間縮短[B組(15.2±6.3) min和D組(17.1±4.4) min,A組(10.4±0.5) min和C組(11.3±0.7) min](P＜0.05).與C組和D組比較,A組和B組(即兩組細針與兩組普通針比較)術中低血壓髮生率降低[C組(18％)和D組(20％),A組(8％)和B組(10％)]、噁心嘔吐髮生率減少[C組(10％)和D組(12％),A組(4％)和B組(5％)]、無術後頭痛和腰痛髮生[C組(3％)和D組(4％),A組(0)和B組(0)](P＜0.05). 結論 坐位細針腰痳,操作簡便,所需時間短,穿刺次數少,成功率高,術中、術後副作用少.
목적 탐토좌위세침요마재급진부궁산술중적림상응용효과. 방법 선택급진부궁산술산부400례,미국마취의사협회(ASA)분급Ⅰ～Ⅱ급,안조수궤수자표법분위4조(매조100례):A조,좌위필첨양세침요마조;B조,측와위필첨양세침요마조;C조,좌위보통사면침요마조;D조,측와위보통사면침요마조.천자성공후주입0.5％포비잡인1.8 ml～2.2 ml(9 mg～11 mg).술필대마취평면소산지T10이하후,송회병방거침평와6h,제1、2、3천급시수방.관찰기록4조산부적혈압、맥박혈양포화도화심솔적변화,기록요마천자차수、천자성공솔、마취조작시간、천자개시도절피시간、절피도태인면출시간이급술중、술후부작용. 결과 여B조화D조비교,A조화C조(즉량조좌위여량조측와위비교)천자차수감소[B조(3.2±0.9)화D조(4.1±0.4),A조(1.1±0.5)화C조(1.2±0.6)]、천자성공솔제고[B조(90％)화D조(92％),A조(100％)화C조(98％)]、천자시간축단[B조(5.2±0.6) min화D조(4.1±0.9) min,A조(1.2±0.8) min화C조(2.1±0.7) min]、마취조작시간축단[B조(7.1±0.5) min화D조(6.2±0.8) min,A조(3.4±0.7) min화C조(4.3±0.6) min]、종천자개시도절피시간축단[B조(15.2±6.3) min화D조(17.1±4.4) min,A조(10.4±0.5) min화C조(11.3±0.7) min](P＜0.05).여C조화D조비교,A조화B조(즉량조세침여량조보통침비교)술중저혈압발생솔강저[C조(18％)화D조(20％),A조(8％)화B조(10％)]、악심구토발생솔감소[C조(10％)화D조(12％),A조(4％)화B조(5％)]、무술후두통화요통발생[C조(3％)화D조(4％),A조(0)화B조(0)](P＜0.05). 결론 좌위세침요마,조작간편,소수시간단,천자차수소,성공솔고,술중、술후부작용소.
Objective To study the effects of sitting position with pencil point spinal needle in spinal anesthesia for emergency Cesarean-section.Methods Four hundred ASA physical status of Ⅰ or Ⅱ parturients undergoing emergency cesarean section were divided randomly into four groups (100 cases each).Spinal anesthesia was performed with pencil pointed needle in sitting position in group A,or with pencil pointed needle in lateral position in group B,or with ordinary inclined plane needle in sitting position in group C,or with ordinary inclined plane needle in lateral position in group D.Spinal anesthesia was induced with 1.8 ml-2.2 ml of 5％ bupivacaine (9 mg-1 1 mg) following successful puncture.The parturients were escorted to wards when analgesia block level dissipated to T10 after operation.All patients must be in supine position for six hours.Postoperation follow-up lasted for three days.The frequency of puncture,puncture time,the rate of successful puncture,the time from skin incision to delivery.Intraoperation and postoperative complications were recorded.Results Compared with group B and D,the frequency of puncture were declined significantly in group A and C[group B(3.2±0.9) and D(4.1±0.4) vs group A(1.1±0.5) and C(1.2±0.6)],the rate of successful puncture were increased [group B (90％) and group D (92％) vs group A (100％) and group C (98％)],the time of puncture were shorter [group B (5.2±0.6) min and D (4.1±0.9) min vs group A (1.2±0.8) min and C (2.1±0.7) min],the time of performed spinal anesthesia were shorter [group B (7.1±0.5) rmin and D (6.2±0.8) min vs group A (3.4±0.7) min and C (4.3±0.6)min],the time from beginning puncture to skin incision were shorter [group B (15.2±6.3) min and D (17.1±4.4) min vs group A (10.4±0.5) min and C (11.3±0.7) min] (P＜0.05).Compared with group C and D,the rate of intraoperation hypotension were reduced in group A and B [group C(18％) and group D (20％) vs group A (8％) and group B (10％],There were no postdural puncture headache and low back pain in group A and B [group C(3％) and group D(4％) vs group A(0) and group B(0)](P＜0.05).Conclusions Spinal anesthesia with fine needle in sitting position is simple to perform and needs shorter time and fewer puncture times and has higher successful rate and fewer intraoperation and postoperation complications.It can be widely used in emergency cesarean section.
