CAJ | 학술논문

目的：评价侧卧位硬膜外腔分段注药在二次硬膜外穿刺患者行连续硬膜外麻醉时麻醉效果及可行性、安全性。方法选择近4~6年内曾行硬膜外麻醉拟行再次剖宫产手术的患者94例，ASAⅠ~Ⅲ级，年龄24~37岁，体质量65~89 kg，采取简单化随机分组法分为侧卧位分段注药组（E 组），对照组平卧位注药组（C 组）。E 组侧卧位下先经穿刺针单次注药，然后第12胸椎~第1腰椎间隙或距穿刺点5 cm 处注药。留置导管在硬膜外腔3.5 cm 作第三次注药。C组平卧位分三次注药。记录三次注药5 min、手术开始前两组阻滞的节段；单双侧阻滞例数；最高平面例数；VAS 评分；不良反应。结果与 C 组比较，三次注药、术前阻滞节段比较差异有统计学意义（P ＜0.05，P ＜0.01）；双侧阻滞差异有统计学意义（P ＜0.05）；各点阻滞的最高平面差异有统计学意义（P ＜0.05，P ＜0.01）；局麻药用量明显减少（P ＜0.01）；仰卧位综合征发生率明显升高（P ＜0.01）；肌松优良低于 E 组。结论二次硬膜外穿刺的患者应用侧卧位分段注药法，遵循少量、多次用药原则，效果良好，安全性高。
목적：평개측와위경막외강분단주약재이차경막외천자환자행련속경막외마취시마취효과급가행성、안전성。방법선택근4~6년내증행경막외마취의행재차부궁산수술적환자94례，ASAⅠ~Ⅲ급，년령24~37세，체질량65~89 kg，채취간단화수궤분조법분위측와위분단주약조（E 조），대조조평와위주약조（C 조）。E 조측와위하선경천자침단차주약，연후제12흉추~제1요추간극혹거천자점5 cm 처주약。류치도관재경막외강3.5 cm 작제삼차주약。C조평와위분삼차주약。기록삼차주약5 min、수술개시전량조조체적절단；단쌍측조체례수；최고평면례수；VAS 평분；불량반응。결과여 C 조비교，삼차주약、술전조체절단비교차이유통계학의의（P ＜0.05，P ＜0.01）；쌍측조체차이유통계학의의（P ＜0.05）；각점조체적최고평면차이유통계학의의（P ＜0.05，P ＜0.01）；국마약용량명현감소（P ＜0.01）；앙와위종합정발생솔명현승고（P ＜0.01）；기송우량저우 E 조。결론이차경막외천자적환자응용측와위분단주약법，준순소량、다차용약원칙，효과량호，안전성고。
Objective To evaluate the effect,feasibility and safety of lateral position epidural sectional drug injection in the two segmental epidural puncture on patients with continuous epidural anesthesia. Methods Ninety-five patients underwent epi-dural anesthesia for cesarean section operation during nearly 4 to 6 years were selected,ASA I to III grade,age 24 to 37 years old,weight 65 to 89 kg. They were divided into lateral position segment injection group(group E),and the control group with supine injection(group C). Group E were given lateral position under the first through the puncture needle with single drug in-jection,then T12 - L1,or from the puncture point gap at 5 cm injection. Indwelling catheter in the epidural space 3. 5 cm third injection. Group C were given supine injection medicine three times. The three times injection at 5 minutes,operation start seg-ment in two groups before anesthesia,the number of cases of unilateral and bilateral block,the highest plane cases number,VAS score,and the adverse reactions were recorded. Results Compared with group C,the three injection,preoperative block seg-ments had significant difference(P < 0. 05,P < 0. 01);bilateral block had significant difference(P < 0. 05);the highest plane of each point block had significant difference(P < 0. 05,P < 0. 01);the amount of local anesthetics decreased significantly (P < 0. 01);supine syndrome were significantly higher(P < 0. 01);muscle relaxation was better in the group E than that in group C. Conclusion Two epidural puncture should adopt the lateral decubitus piecewise injection,followed by smaller,after repeated use of principle. The effect is good,and it is safe.