旁正中入路穿刺法在高龄患者髋部手术 腰硬联合麻醉中的应用

Application of paramedian approach puncture in combined spinal and epidural anesthesia for hip surgery in elderly patients

摘要:

目的 探讨腰硬联合麻醉正中入路与旁正中入路穿刺法在高龄患者髋部手术中优劣性。 方法 选取2018 年4 月—2018 年12 月于延安大学附属医院就诊的115 例年龄>75 岁行髋部手术的患者，均实 施腰硬联合麻醉，按随机数字表法分为正中入路组和旁正中入路组。观察两组患者重复穿刺、硬膜外导管置管 失败、硬膜外置管引起感觉异常、硬膜外导管置入血管、脊麻成功和穿刺后5 d 腰背部疼痛的例数。结果 旁 正中入路组脊麻成功率高于正中入路组（P <0.05），重复穿刺率、置管失败率、感觉异常率及置管出血率 低于正中入路组（P <0.05）。旁正中入路组术后5 d 腰背痛发生率低于正中入路组（P <0.05）。结论 旁正 中入路比正中入路更适用于高龄患者硬- 腰联合麻醉，其有更高的脊髓麻醉成功率和更低的腰背部疼痛发 生率。

Abstract:

Objective To compare the advantages and disadvantages of the median approach and the paramedian approach for the combined spinal and epidural anesthesia in the hip surgery of elderly patients. Methods Totally 115 elderly patients with hip surgery, over than 75 years, ASA Ⅰ- Ⅲ level, accepting combined spinal and epidural anesthesia (CSEA), according to random number table method, were divided into the median approach group (M group) and the paramedian approach group (P group). The number of repeated punctures, the number of unsuccessful inserting catheter in epidural space, the number of paresthesia caused by epidural catheter, the number of inserting catheter in blood vessels, the number of successful spinal anesthesia and the number of backache at 5 days after puncture were observed. Results Compared the median approach (M group), the rate of successful spinal anesthesia in paramedian approach group (P group) was improved (P < 0.05); and compared with M group, the rate of repeat puncture, the incidence of unsuccessful inserting catheter, the incidence of paresthesia caused by epidural catheter, the incidence of inserting catheter in blood vessels and the incidence of backache in P group were reduced (P < 0.05). Conclusion Paramedian approach is more suitable than median approach for combined spinal and epidural anesthesia in elderly patients, with higher success rate of spinal anesthesia and lower incidence of backache.