确定硬膜外麻醉阻滞平面的临床方法

目的探讨测定硬膜外麻醉阻滞平面的3种方法的可行性。方法 326例下腹部手术病人均取T12～L1间隙进行硬膜外穿刺,头向置管3.5 cm。注入局麻药后依次用触摸皮肤摩擦阻力改变法、酒精接触皮肤冷感觉消退法、针刺皮肤痛觉消退法来测定阻滞平面上界。其中24例不能表达感觉消退区域者用触摸皮肤摩擦阻力改变法测定。结果对一般患者3种方法均能测出麻醉平面,并且反应出各神经不同的阻滞范围。对24例不能表达感觉消退区域的患者通过用指腹感觉皮肤摩擦阻力变化均能测出交感神经阻滞平面,从而推断出感觉神经阻滞平面。结论临床上3种测定阻滞平面的方法均应掌握,提倡用酒精接触代替针刺,以免给患者造成伤害;用手指触摸皮肤摩擦阻力改变测试平面,对某些患者如痴呆、听觉障碍、语言不通、精神过度紧张者有重要意义。

Clinical Methods to Determine the EA Blockage Plane

Objective To study the feasibility of three methods in determine the Ea blockage plane.Methods In 326 hypogastrium operation examples,epidural paracentesis were taken on patients’ T12-L1 interspace with placing 3.5 cm cephalad tube.Determine the Ea blockage plane upperbound after injecting local anesthetic by the ways of feeling the changing of skin friction force of resistance by touching,cold sensation regression after touching the skin with alcohol,algaesthesis regression after acupuncture on the skin in turn.There are 24 examples among which patients could not express the area of sensation regression determined by the way of feeling the changing of skin friction force of resistance by touching.Results For common patients the anesthesia plane can be determined by all the three methods,which can reflect different blockageamplitude of each nerves.In the other 24 examples patients’ blockage plane of adrenergic nerve can be determined by the way of feeling the changing of skin friction force of resistance by touching,and thereby conclude the blockage plane of sensory nerve.Conclusions The three methods of determining blockage plane should be mastered,and I promote to remove the algaesthesis regression after acupuncture on the skin with cold sensation regression after touching the skin with alcohol in order to avoid harm on patients.It has great meaning to those who are aphrenia,with auditory handicap,or linguistic difficulties,to determine the plane by feeling the changing of skin friction force of resistance by touching.