骶管麻醉寻找落空感与骨性标志的效果评价
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摘要
目的探讨痔疮手术中骶管麻醉寻找落空感与寻找骨性标志的麻醉效果。方法选择择期行痔疮手术患者60例。采用随机数字表法分为两组,每组30例患者。A组患者在骶管麻醉操作过程中寻找落空感(即突破韧带到达骶管腔)进行麻醉。B组患者在骶管麻醉操作中以寻找骨性标志即骶裂孔而不追求出现落空感进行麻醉。两组患者手术方式、麻醉药物、药物浓度均相同的前提下,观察并记录麻醉效果、VAS疼痛评分、血流动力学、麻醉相关不良反应及并发症。结果两组患者术前一般情况无统计学差异。A组操作时间(5.18±1.3)min较B组操作时间(3.15±0.8)min长,差异有统计学意义(P<0.05);A组麻醉维持时间(4.47±0.7)h较B组麻醉维持时间(3.5±0.5)h长,差异有统计学意义(P<0.05)。但是两组患者术中麻醉效果、VAS疼痛评分、血流动力学差异没有统计学意义(P>0.05)。讨论骶管麻醉操作中寻找落空感与寻找骨性标志的麻醉效果均可满足痔疮手术需求,针对解剖变异及定位不准确的患者可采用寻找骨性标志的方法进行骶管麻醉。
Objective To explore the anesthesia effect of sacral anesthesia in finding sense of loss and finding bone signs; Methods60 patients with elective hemorrhoids were selected. Using randomnumber table method divided into two groups, each group of 30 patients.A group of patients in the sacral anesthesia operation process to find a sense of loss(that is, break through the ligament to the sacral lumen)for anesthesia. Group B patients in the sacral anesthesia operation process to find the bony signs that sacral hiatus without the pursuit sense of loss of anesthesia. The anesthesia effect, VAS pain score, hemodynamics, anesthesia-related adverse reactions and complications were observed and recorded under the condition that the two groups were the same way of operation, narcotic drugs and drug concentration.Result There was no statistically significant difference between the two groups before surgery. The operation time of group A(5.18±1.3)min was longer than that of group B(3.15±0.8)min, and the difference was statistically significant(P < 0.05).The duration of anesthesia maintenance in group A(4.47±0.7) hwas longer than that in group B(3.5±0.5)h, the difference was statistically significant(P <0.05).However, there was no statistically significant difference in intraoperative anesthesia, VAS pain score and hemodynamics between the two groups(P> 0.05). Conclusion Anesthesia in the operation of the sacral anesthesia to find a sense of loss and looking for bone signs of anesthesia can meet the needs of hemorrhoids surgery.For patients with anatomical variations and inaccurate positioning, sacral anesthesia can be performed by finding a bone signs.
Objective To explore the anesthesia effect of sacral anesthesia in finding sense of loss and finding bone signs; Methods60 patients with elective hemorrhoids were selected. Using randomnumber table method divided into two groups, each group of 30 patients.A group of patients in the sacral anesthesia operation process to find a sense of loss(that is, break through the ligament to the sacral lumen)for anesthesia. Group B patients in the sacral anesthesia operation process to find the bony signs that sacral hiatus without the pursuit sense of loss of anesthesia. The anesthesia effect, VAS pain score, hemodynamics, anesthesia-related adverse reactions and complications were observed and recorded under the condition that the two groups were the same way of operation, narcotic drugs and drug concentration.Result There was no statistically significant difference between the two groups before surgery. The operation time of group A(5.18±1.3)min was longer than that of group B(3.15±0.8)min, and the difference was statistically significant(P < 0.05).The duration of anesthesia maintenance in group A(4.47±0.7) hwas longer than that in group B(3.5±0.5)h, the difference was statistically significant(P <0.05).However, there was no statistically significant difference in intraoperative anesthesia, VAS pain score and hemodynamics between the two groups(P> 0.05). Conclusion Anesthesia in the operation of the sacral anesthesia to find a sense of loss and looking for bone signs of anesthesia can meet the needs of hemorrhoids surgery.For patients with anatomical variations and inaccurate positioning, sacral anesthesia can be performed by finding a bone signs.
引文
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[2]安刚,薛富善.现代麻醉学技术[M].北京:科学技术文献出版社,2001:287-289
[3]陈红锦,曾莉.骶管阻滞麻醉在肛门直肠手术中的应用[J].中国普通外科杂志,2004,13(4):315-315.
[4]邓兆宏,姚柏春,张一飞等.骶管阻滞入路相关结构的应用解剖[J].中国疼痛医学杂志,2006,12(6):357-359.
[5]Sheng-Chin Kao,Chia-Shiang Lin.Caudal Epidural Block:An Updated Reviewof Anatomy and Techniques[J].Biomed Res Int.2017;2017:9217145.
[6]何金哲,袁建虎,杨茜芳.3681例肛肠手术改良骶管阻滞效果评价[J].北京医学,2012,34(8):699
[7]王波.128例骶管麻醉应用于肛肠科手术的临床研究[J].中国实用医药,2014,(19):160-161.
[8]陈益,龚璇,朱琼等.骶管阻滞在成人PPH术中的临床观察[J].长江大学学报(自科版)医学下旬刊,2014,11(2):11-12.
[9]徐启明,李文硕.临床麻醉学[M].北京:人民卫生出版社,2000:136.
[10]古昌剑,曹振刚,张健莉,等.0.5%罗哌卡因与0.5%布比卡因硬膜外麻醉在前列腺电切手术的临床对比[J].新疆医学,2014,44(08):93-94.