中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
7期
1003-1005
,共3页
王玉玲%邱郁群%阮志琴%陈艳%黄梅
王玉玲%邱鬱群%阮誌琴%陳豔%黃梅
왕옥령%구욱군%원지금%진염%황매
椎管内麻醉%神经并发症%地塞米松
椎管內痳醉%神經併髮癥%地塞米鬆
추관내마취%신경병발증%지새미송
Intravertebral anesthesia%Neurological complications%Dexamethasone
目的 探讨地塞米松对椎管内麻醉过程中出现神经并发症的预防效果.方法 2005年1月至2009年10月在椎管内麻醉穿刺、置管等操作过程中出现异感1 870例为对照组,以2009年11月至2013年5月出现异感的1 548例患者为治疗组.对照组患者以2 ml/h速度给予0.125％左布比卡因100 ml与舒芬太尼100 μg的硬膜外腔术后镇痛;治疗组患者经硬膜外腔注入地塞米松10 mg,然后行经静脉术后镇痛治疗,镇痛液为舒芬太尼100 μg与布托非诺5 mg,0.9％氯化钠注射液稀释至100 ml.观察2组患者触发异感情况、神经并发症类型及治疗效果,并进行统计学分析.结果 2组患者触发异感时针尖同位置比较,差异无统计学意义(P＞0.05).治疗组异感程度a、b、c级分别为1 249例(80.7％)、245例(15.8％)、54例(3.5％);对照组分别为1 227例(65.6％)、481例(25.7％)、162例(8.7％),2组患者同级异感程度比较,差异具有统计学意义(P＜0.05).治疗组发生暂时性神经根激惹(TNS) 968例(62.5％)、马尾综合征194例(12.5％)、神经刺激征97例(6.3％)、延迟性骶神经感觉障碍0例(0.0％)、其他神经并发症289例(18.7％);对照组分别为650例(34.8％)、386例(20.6％)、163例(8.7％)、3例(0.2％)、528例(28.2％).对照组TNS比例明显低于治疗组,组间比较差异有统计学意义(P＜0.05);而马尾综合征、延迟性骶神经感觉障碍发生率高于治疗组,组间比较差异有统计学意义(P＜0.05).结论 通过地塞米松对椎管内穿刺神经并发症进行早期干预,能明显减少穿刺引起的神经并发症发生率,患者症状轻,易于恢复.
目的 探討地塞米鬆對椎管內痳醉過程中齣現神經併髮癥的預防效果.方法 2005年1月至2009年10月在椎管內痳醉穿刺、置管等操作過程中齣現異感1 870例為對照組,以2009年11月至2013年5月齣現異感的1 548例患者為治療組.對照組患者以2 ml/h速度給予0.125％左佈比卡因100 ml與舒芬太尼100 μg的硬膜外腔術後鎮痛;治療組患者經硬膜外腔註入地塞米鬆10 mg,然後行經靜脈術後鎮痛治療,鎮痛液為舒芬太尼100 μg與佈託非諾5 mg,0.9％氯化鈉註射液稀釋至100 ml.觀察2組患者觸髮異感情況、神經併髮癥類型及治療效果,併進行統計學分析.結果 2組患者觸髮異感時針尖同位置比較,差異無統計學意義(P＞0.05).治療組異感程度a、b、c級分彆為1 249例(80.7％)、245例(15.8％)、54例(3.5％);對照組分彆為1 227例(65.6％)、481例(25.7％)、162例(8.7％),2組患者同級異感程度比較,差異具有統計學意義(P＜0.05).治療組髮生暫時性神經根激惹(TNS) 968例(62.5％)、馬尾綜閤徵194例(12.5％)、神經刺激徵97例(6.3％)、延遲性骶神經感覺障礙0例(0.0％)、其他神經併髮癥289例(18.7％);對照組分彆為650例(34.8％)、386例(20.6％)、163例(8.7％)、3例(0.2％)、528例(28.2％).對照組TNS比例明顯低于治療組,組間比較差異有統計學意義(P＜0.05);而馬尾綜閤徵、延遲性骶神經感覺障礙髮生率高于治療組,組間比較差異有統計學意義(P＜0.05).結論 通過地塞米鬆對椎管內穿刺神經併髮癥進行早期榦預,能明顯減少穿刺引起的神經併髮癥髮生率,患者癥狀輕,易于恢複.
목적 탐토지새미송대추관내마취과정중출현신경병발증적예방효과.방법 2005년1월지2009년10월재추관내마취천자、치관등조작과정중출현이감1 870례위대조조,이2009년11월지2013년5월출현이감적1 548례환자위치료조.대조조환자이2 ml/h속도급여0.125％좌포비잡인100 ml여서분태니100 μg적경막외강술후진통;치료조환자경경막외강주입지새미송10 mg,연후행경정맥술후진통치료,진통액위서분태니100 μg여포탁비낙5 mg,0.9％록화납주사액희석지100 ml.관찰2조환자촉발이감정황、신경병발증류형급치료효과,병진행통계학분석.결과 2조환자촉발이감시침첨동위치비교,차이무통계학의의(P＞0.05).치료조이감정도a、b、c급분별위1 249례(80.7％)、245례(15.8％)、54례(3.5％);대조조분별위1 227례(65.6％)、481례(25.7％)、162례(8.7％),2조환자동급이감정도비교,차이구유통계학의의(P＜0.05).치료조발생잠시성신경근격야(TNS) 968례(62.5％)、마미종합정194례(12.5％)、신경자격정97례(6.3％)、연지성저신경감각장애0례(0.0％)、기타신경병발증289례(18.7％);대조조분별위650례(34.8％)、386례(20.6％)、163례(8.7％)、3례(0.2％)、528례(28.2％).대조조TNS비례명현저우치료조,조간비교차이유통계학의의(P＜0.05);이마미종합정、연지성저신경감각장애발생솔고우치료조,조간비교차이유통계학의의(P＜0.05).결론 통과지새미송대추관내천자신경병발증진행조기간예,능명현감소천자인기적신경병발증발생솔,환자증상경,역우회복.
Objective To observe the prevention effects of dexamethasone on the neurological complications occurred during the intravertebral anesthesia.Methods One thousand eight hundred and seventy patients who had abnormal sensation when they were conducted puncture and catheterization after intravertebral anesthesia from January 2005 to October 2009,were regarded as the control group,while the other 1 548 cases patients who had abnormal sensation from November 2009 to May 2013 were regarded as the treatment group.In the form of epidural anesthesia,the 0.125％ levobupivacaine of 100 ml and sufentanil of 100 μg were conducted at the speed of 2 ml/h for the patients in the control group.The dexamethasone of 10 mg was injected through epidural cavity for the patients in the treatment group,then conducting the intravenous analgesia after operation.The analgestic liquid is the sufentanil of 100 μg and butorphanol of 5 mg diluting to 100 ml with the physiological saline.The occurring of abnormal sensation,types of neurological complications and treatment effects of the patients in two groups were observed,then making the statistical analysis.Results The locations of tips for stimulating the abnormal sensations in two groups were the same,the differences had no statistical significance (P ＞ 0.05).The degrees of abnormal sensation for grade a,b and c in the treatment group were respectively 1 249 cases (80.7％),275 cases (15.8％),54 cases (3.5％),while those in the control group were respectively 1 227 cases (65.6％),481 cases (25.7％) and 162 cases (8.7％).After comparing the abnormal sensation with the same grade of the patients in two groups,the differences had statistical significance (P ＜ 0.05).The types of neurological complications in the treatment group were as follows:TNS of 968 cases (62.5％),CES of 194 cases (12.5％),nerve stimulation of 97 cases (6.3％),delayed sacral nerve sensory obstacle of o case (0.0％),other neurological complications of 289 cases (18.7％),while those in the control group were respectively 650 cases (34.8％),386 cases (20.6％),163 cases (8.7％),142 cases (7.6％) and 528cases (28.2％).The ratio of TNS in the control group was obviously lower than that in the treatment group.The differences between two groups had statistical significance (P ＜ 0.05),while the incidences of CES and delayed sacral nerve sensory obstacle were higher than those in the control group.The differences between two groups had the statistical significance (P ＜ 0.05).Conclusion The early intervention of dexamethasone for the neurological complications caused by intravertebral puncture can obviously drop the incidences of neurological complications caused by the puncture and the patients are characterized with light symptom and easy recovery.
