国际麻醉学与复苏杂志   2012, Issue (2): 1-1
    
硬膜外腔特异压力波形用于硬膜外穿刺麻醉效果分析
石海霞, 龚玉华, 武丽芳, 韩志强, 拉布旦白拉, 陈冬梅1()
1.内蒙古医学院附属医院
Tests for evaluation of epidural pressure dynamic graph as the epidural anesthesia effect
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摘要:

目的 比较特异性压力波形与传统针刺测试麻醉平面行硬膜外麻醉的效果,探讨特异性压力波形预测硬膜外麻醉效果的可行性。 方法 拟于硬膜外麻醉下行择期胆囊切除手术患者600例,ASAⅠ~Ⅲ级,年龄、体重、性别不限。根据特异性压力波形辅助方法,随机分为2组:试验组(T9-10, T组300例),对照组(T9-10, C组300例)。所有患者均采用直入法进针,常规盲探突破法(阻力消失)进入硬膜外腔,两组均予以气泡盐水无压缩证实进入硬膜外腔,置管成功后对照组按常规注入试验量5ml局麻药,试验组连接压力监测装置,观察记录压力图像判断麻醉效果,直接予以初量10~12ml局麻药(不注试验量)。对照组采用针刺法确定麻醉效果及平面。记录两组穿刺结束至手术开始时间、阻滞效果、各类不良反应。试验组记录观察分次注药后压力波形变化。结果 两组穿刺结束至手术开始时间比较,试验组明显缩短(P<0.05)。试验组压力持续12 mmHg ~25mmHg,且为正弦波形,麻醉效果满意;压力值≧30 mmHg,且波形为直线,麻醉效果差。压力波形特异性与麻醉效果存在相关关系。结论 在保留传统硬膜外腔穿刺优点的同时,特异性压力波形可预知硬膜外麻醉效果,在注入试验量前可明确硬膜外麻醉成功与否,提高了硬膜外麻醉精确性。

关键词: 硬膜外腔;波形,压力;监测
Abstract:

Objective To observe epidural pressure dynamic graph as an objective test evaluation of epidural anesthesia effect, whose feasibility. Methods selective epidural anesthesia 600 patients ( ASAⅠ~Ⅲ, age, sex, weight , which were not limited )were approached for enrollment. According to the directed way, they were divided into 2 groups in random: Trial group (T9-10, Group T), Control group (C9-10, Group C), each enrolled 300 patients. Continuously recorded the pressure graph. All patients were punctured by normal beam testing and punctured as usual in blind. . Trial group were connected with the epidural pressure graph equipment. Record the time between end of puncture and the start of the operation, the block effect, complications. In Group T, observe the pressure graph character after injecting drug. Results Compared the time between the end of epidural puncture and the start of operation, the patients in trial group were shorter (P<0.05). In trial group, epidural pressure is between 12mmHg ~25mmHg in balance, the anesthesia effect is good, while pressure≧30 mmHg and the graph was line, the anesthesia effect is bad. The specific pressure graph had correlation with the epidural anesthesia effect (P<0.05). Conclusion Epidural pressure dynamic graph, which can predict the anesthesia success and the effect before injecting the trial dose of local anesthesia drug, not increased the puncture time and the injury. It is facilitated in every epidural scope and every age in security and validity, generalize epidural anesthesia application.

Key words: Epidural space; Graph, dynamic pressure; Monitor