摘要
目的比较腰硬联合麻醉穿刺中旁正中入路与正中入路两种方法在高龄患者TURP手术中的优劣性。方法选择本院2019年1—10月择期行TURP手术患者100例,年龄65~85岁,ASAⅠ~Ⅲ级,无椎管内麻醉相关禁忌证,随机分为正中入路组(M组)与旁正中入路组(P组),每组各50例。两组患者均选择L4~5间隙,M组患者采用常规脊柱中正入路穿刺行腰硬联合椎管内阻滞;P组患者以旁正中入路即脊柱正中线下旁开1~1.5 cm穿刺置管行腰硬联合麻醉。观察记录两组患者麻醉穿刺操作成功率,重复穿刺及硬膜外导管置管失败例数;并观察两组患者穿刺与置管引起下肢感觉异常、硬膜导管置入血管及穿刺后7 d腰背部疼痛等不良反应。结果与M组比较,P组穿刺成功率明显高于M组(P<0.05);硬膜外置管失败、下肢感觉异常、硬膜外导管置入血管及患者术后腰背疼痛的发生率明显降低(P<0.05)。结论与传统正中穿刺入路相比,旁正中入路具有更高的脊髓麻醉穿刺成功率与更低的不良反应发生率,更适用于高龄TURP患者腰硬联合麻醉。
Objective To compare the advantages and disadvantages of two methods of combined spinal and epidural anesthesia puncture with paramedian approach and with median approach in transurethral resection of the prostate(TURP)in elderly patients.Methods A total of 100 patients of American Society of Anesthesiologists(ASA)gradeⅠ-Ⅲand without intraspinal anesthesia-related contraindications who aged 65-85 years and underwent elective TURP in our hospital from January to October 2019 were selected as the study subjects.They were randomly divided into the median approach group(group M)and the paramedian approach group(group P),with 50 patients in each group.The L4-5 gap was applied in patients in both groups.Patients in group M underwent the conventional combined spinal and epidural anesthesia puncture with median approach in the spine combined with intraspinal block,while the operation for patients in group P was performed with a paramedian approach,i.e.,an incision of 1-1.5 cm below the median line of the spine was made to perform the combined spinal and epidural anesthesia via puncture catheterization.The success rate of anesthesia puncture,the number of repeated puncture and failed epidural catheterization in both groups were observed and counted.The adverse reactions such as abnormal sensation in the lower limbs,the epidural catheter misplaced into the vessels and pain in the lower back at 7 days after puncture in both groups were observed.Results The success rate of puncture in group P was significantly higher than that in group M(P<0.05).Meanwhile,the incidences of failed epidural placement,abnormal sensation in the lower limbs,epidural catheter misplaced into the vessels and pain in the lower back after operation were significantly lower in group P than those in group M(P<0.05).Conclusion Compared with the traditional median puncture approach,the paramedian approach has a higher success rate of spinal anesthesia puncture and a lower incidence of adverse reactions,which is more suitable for the combined spinal an
作者
金峰
唐在荣
徐知菲
JIN Feng;TANG Zairong;XU Zhifei(Department of Anesthesiology,Gaoyou Hospital of Traditional Chinese Medicine of Jiangsu Province,Gaoyou 225600,China)
出处
《中国现代医生》
2021年第32期137-139,共3页
China Modern Doctor
关键词
腰硬联合麻醉
正中入路
旁正中入路
高龄
TURP
Combined spinal and epidural anesthesia
Median approach
Paramedian approach
Elderly patients
Transurethral resection of the prostate
