硬―腰联合麻醉腰穿脑脊液引流困难临床分析.docVIP

硬―腰联合麻醉腰穿脑脊液引流困难临床分析 　　【摘要】 目的：分析硬-腰联合麻醉腰穿脑脊液引流困难原因和分型。方法：回顾分析2013年1-11月硬-腰联合麻醉，ASA分级Ⅰ～Ⅲ级下腹部以下手术，排除体重过大、脊柱畸形、身高过高和过低者。患者采取侧卧位，选择腰（L）3～4～5椎间隙硬外穿刺。硬外穿刺针采用Touhy 16G，压力试验应用低阻力注射器。硬-腰联合麻醉穿刺三次均失败病例，改用其他方法穿刺。结果：统计到符合条件的病例3560例，其中产科1698例，妇科1185例，普外科346例，泌尿外科331例；应用正中入路穿刺法（Z）、“把持式”锐角侧入路穿刺法（B）。两种穿刺方法，一次腰穿成功共计3915次例，其中355例为Z方法失败后，改为B方法的病例。腰穿脑脊液引流困难，可以分为完全引流不出脑脊液（Ⅰ型）、脑脊液引流不畅（Ⅱ型）。“把持式”锐角侧入路方法腰穿脑脊液引流困难发生率Ⅰ型2%、Ⅱ型3%，正中入路方法腰穿脑脊液引流困难发生率Ⅰ型12%、Ⅱ型11%，差异有统计学意义（P0.05）。结论：腰穿脑脊液引流困难发生率“把持式”锐角侧入路方法较正中入路方法低。 　　【关键词】 硬-腰联合麻醉； 持续正压； 锐角； 侧入路； 硬膜外腔穿刺术 　　中图分类号 R614.4 文献标识码 B 文章编号 1674-6805（2015）21-0022-03 　　【Abstract】 Objective：To analyze the causes and type of difficulty cerebrospinal fluid drainage on spinal-epidural anesthesia.Method：Retrospectively analysis of clinical cases of spinal-epidural anesthesia and ASAⅠ-Ⅲ and the surgeries lower abdomen from January 2013 to November 2013，overweight，spinal deformity，height was too high and too low were excluded.The patients taken lateral position，epidural puncture with Touhy 16G needle and low resistance syringe between L3-4-5.3 times failure used other methods.Result：3560 cases were collected，1698 cases of obstetric，gynecological was 1185 cases，346 cases of general surgery，urology was 331 cases；2 epidural puncture methods were used，included perpendicularity epidural cavity puncture by center approach（Z），the “Bcs” acute angle epidural cavity puncture by lateral approach（B）.3915 cases were succeed in first try and 355 cases were succeed by B when Z failure in these.The hardly drainage of cerebrospinal fluid can be divided into the completely no drainage（typeⅠ），inadequate drainage（typeⅡ）.Type Ⅰ was 2%，type Ⅱ was 3% by “B”.Type Ⅰ was 12%，type Ⅱ was 11% by “Z”，there were statistic significance（P0.05）.Conclusion：The rate of hardly drainage of cerebrospinal fluid of the “Bcs” acute angle epidural cavity puncture by lateral approach is lower than that of perpendicularity epidural cavity puncture by center approach. 　　【Key words】 Spinal-epidural anes