肾移植硬膜外麻醉预防硬膜外出血并发症临床探究.docVIP

肾移植硬膜外麻醉预防硬膜外出血并发症临床探究【摘要】目的：比较三种不同材料的硬膜外导管用于肾移植患者硬膜外置管时误入血管的发生率。方法 62例行肾移植患者随机分为三组，均选硬膜外麻醉，Ⅰ组用国产的普通硬膜外穿刺包里的硬膜外导管，Ⅱ组用BD公司生产的腰硬联合麻醉包内的硬膜外导管，Ⅲ组用ARROW公司生产的加强型硬膜外导管。结果 Ⅰ、Ⅱ组误入血管的几率相近，分别为23.80%和20.00%，而Ⅲ组的发生率明显减少，为0%。结论 加强型硬膜外导管可明显减少误入血管的发生率，能有效地预防硬膜外出血，尤其适用于肾移植术的麻醉。 【关键词】肾移植；硬膜外导管，硬膜外麻醉 Clinical Research of Prevention of Extradural Hemorrhage Complication in Epidural Anesthesia in Kidney Transplantation Huang Jianzhong1，Lin Yushuang1，Huang Wenqi2 1．Department of Anesthesiology,Zhangzhou Municipal Hospital of Fujian Medical University,363000 2．Department of Anesthesiology , No.1 Affiliated Hospital of Zhongshan University,510120 【Abstract】 Object：To study and compare the incidence of vein injury which caused extradural hemorrhage with three epidural ducts used in kidney transplantation.Methods:Sixty-two patients underwent epidural anesthesia were divided into three groups randomly as follow：GroupⅠ(n=21)(with common epidural duct),GroupⅡ(n=20)(with epidural duct produced by BD company) and Group Ⅲ(n=21)(with strengthen epidural duct produced by ARROW company).Result: The morbidity of extradural hemorrhage in GroupⅠwas 23.80% ,as much as that in GroupⅡ which was 20.00%.Meanwhile,it occured far less in Group Ⅲ which had no extradural hemorrhage case.Conclusion:To use the strengthen epidural duct can reduce the incidence of extradural hemorrhage apparently and it was applicable for epidural anesthesia ,especilly in kidney transplantations. 【Key words】：kidney transplantation;epidural duct,epidural anesthesia 肾移植患者常有凝血异常，硬膜外麻醉时有硬膜外血肿之虑。不同材料的硬膜外导管能否减少误入血管的发生，从而减少硬膜外出血的危险。本研究拟采用双盲随机对照试验方案，比较三种硬膜外导管用于肾移植的麻醉，为临床应用提供参考。 1 资料与方法 1.1 一般资料 62例ASAⅢ级肾移植患者，术前无活动期凝血功能障碍，无严重贫血、脊柱畸形、穿刺部位感染等异常，距离最后一次血液透析超过24小时。 1.2 麻醉方法 常规禁食，入室行颈内静脉置管，之后选T12-L1以正中入路法行硬膜外穿刺，由专人操作，留管3.5cm。观察由另一人负责。到达硬膜外腔时采用三种硬膜外导管置管：Ⅰ组用浙江伏尔特医疗器械有限公司生产的硬膜外穿刺包里的硬膜外管（20G×80cm），Ⅱ组用BD公司生产（由苏州碧迪医疗器械有限公司包装）的腰硬联合麻醉包里的硬膜外管（20G×90cm），Ⅲ组用ARROW公司生产（前茂公司包装）的加强型硬膜外管（19G×90cm，管壁钢丝加强）。置管后无回血者以0.75％～1％Ropivacaine12～15m