2050例硬膜外阻滞药物扩散再认识_0.docVIP

2050例硬膜外阻滞药物扩散再认识 ［摘要］ 目的 探讨硬膜外阻滞初量在不同穿刺点的扩散情况。资料与 方法 2050例硬膜外阻滞病例，详细记录初量的阻滞节段数，并根据不同穿刺部位分别 计算 出阻滞每节段需要量。结果 以穿刺点扩散，在中位穿刺点的向头和尾扩散无差别（P0.05），在低位穿刺点的向头扩散明显少于尾扩散（P0.01）；总扩散节段数中位穿刺点少于低位；中位和低位穿刺点阻滞每节段需要量分别为1.31±0.53 ml和1.14±0.50ml（P0.01），随穿刺点下移，节段需要量有减少趋势。结论 中位穿刺点阻滞每节段需要量多于低位穿刺点，且向头端扩散不明显多于尾端。 关键词：麻醉，硬膜外；初量 Abstract Objective To explore the relationship between the spread and the initiative dose of local anesthetics in the epidural apace with different level of epidural puncture. Methods The number of dermatomes blockade at the level of epidural puncture were obtained after administration of initiative local anesthetics dose in 2050 patients undergoing epidural blockade anesthesia. The required dose of local anesthetics to get analgesia per dermatome was calculated according to the anesthetics dose and the number of dermatomes blockade. Results The number of dermatomes blockade towards the cranial and caudal was not significant difference in middle epidural blockade, but the number of dermatomes blockade towards the cranial was significantly less than that towards the caudal in low epidural blockade. The total number of dermatomes blockade in middle epidural blockade was significantly less compared with that in low epidural blockade. The dose of local anesthetics per dermatome was (1.31±0.53) ml in middle epidural blockade, which was significant more than (1.14±0.50) ml in low epidural blockade. The dose for per dermatome was decreased with downward of epidural puncture. Conclusion The dose of local anesthetics per dermatome in middle epidural blockade was significantly more than the in low epidural blockade. The drug spread towards the cranial was not significantly more than that towards caudal in the epidural space after administration of the initiative dose of local anesthetics. Key words: anesthesia, epidural; initiative dose 传统认为，在硬膜外腔麻醉时穿刺点的高低对局麻药需要量和扩散范围是不同的 [1-4]，在早期 文献 还陈述以穿刺为界向头侧扩散大于向尾侧扩散 [5]，胸椎（T）注入要广于颈椎（C）注入[6]，近来有不同的报道[7，8]。为此对近十年2050例硬膜外阻滞麻醉资料进行了回顾性 分析