右半结肠切除术中椎管内麻醉阻滞平面与牵拉反应关系分析_临床医学论文.docVIP

右半结肠切除术中椎管内麻醉阻滞平面与牵拉反应关系分析_临床医学论文 右半结肠切除术中椎管内麻醉阻滞平面与牵拉反应关系分析_临床医学论文 【摘要】 目的 探讨右半结肠切除术中椎管内麻醉阻滞平面与牵拉反应的关系。方法 118例腰-硬联合麻醉下行右半结肠切除术患者,按术中牵拉肠管时阻滞平面的不同分为：A组，阻滞平面高于T5；B组，等于T5；C组，等于T6；D组，低于T6。牵拉反应分Ⅰ～Ⅲ级。记录每组牵拉反应情况。结果 A、B、C组中Ⅰ级牵拉反应发生率明显多于D组（0.01）,A、B组中Ⅰ级牵拉反应发生率与C组比较差异有统计学意义（0.01）,而A、B组间Ⅰ级牵拉反应发生率无明显差异(Pgt;0.05）。结论 腰-硬联合麻醉阻滞平面等于或高于T5时能较好地抑制右半结肠切除术中的牵拉反应。 【关键词】 腰-硬联合麻醉；阻滞平面；右半结肠切除术；牵拉反应 Abstract: Objective To investigate the relationship between block levels of intravertebral anesthesia and traction reactions during right hemicolectomy. Methods 118 patients undergoing right hemicolectomy under combined spinal-epidural anesthesia (CSEA), were divided into groups A, B, C and D, according to block levels, which were above or at T5, at or below T6, respectively. The traction reactions were graded intoⅠ, Ⅱ and Ⅲ. Conditions of traction reaction in each group were recorded. Results The prevalence of grade Ⅰ traction reactions were significantly higher in A, B, C groups than that in group D, respectively (0.01). The prevalence of grade Ⅰ traction reactions in group A and B had significant statistical differences compared with that in group C respectively (0.01). The prevalence of grade Ⅰ traction reactions had no statistical difference between groups A and B (Pgt;0.05). Conclusion When block levels of combined spinal-epidural anesthesia were above or at T5, the traction reactions during right hemicolectomy could be adequately inhibited. Key words: combined spinal-epidural anesthesia; block level; right hemicolectomy; traction reaction 有研究认为，由于结肠左曲以上肠胃受交感神经和迷走神经中的副交感纤维的双重支配，在椎管内麻醉下行此部位手术时，阻滞平面应达T4～L1，以阻滞内脏神经交感神经支，但由于迷走神经支不可能被阻滞，为消除术中的牵拉反应，可辅助内脏神经局麻药封闭或应用镇痛镇静药［1-3］。我们在临床工作中发现：右半结肠切除术的手术部位虽在上述肠管范围内，但术中牵拉反应的发生与阻滞平面有关。本研究的目的是观察并分析腰-硬联合麻醉阻滞平面与右半结肠切除术中牵拉反应的关系，探讨其规律，以尽量减少术中牵拉反应的发生。 1 资料和方法 1.1 一般资料 腰-硬联合麻醉下行右半结肠切除术患者118例，ASAⅠ～Ⅱ级。男65例，女53例，年龄30～57岁。 1.2 麻醉方法 患者入室后，监测心电图（ECG）、动脉血压（ABP）、脉搏血氧饱和度（SpO2），建立静脉通道。患者取左侧卧位，于T11～12间隙行硬膜外腔穿刺，成功后向头侧置管4 cm；于L2～3间隙行蛛网膜下腔穿刺，见脑脊液流出后注入0.75%布比卡因2 ml+10%葡萄糖