脊麻硬膜外联合麻醉时硬膜外试验剂量有效性的观察
作者：黄科昌 殷玉水 郑吉健 王秀莹
单位：潍坊医学院附属医院麻醉科 潍坊 261031
关键词：麻醉；脊髓；麻醉；硬膜外；试验剂量；肾上腺素
潍坊医学院000123摘 要：目的观察脊麻硬膜外联合麻醉(CSEA)时脊麻(SA)作用是否影响含肾上腺素硬膜外试验剂量(TD)的有效性。方法25例CSEA病人，静脉或硬膜外注射2%利多卡因3ml(含肾上腺素15ug)。SA前仅静注，SA后30～40min时先后随机交叉间隔10min静脉和硬膜外注药。观察SA最大平面和注药后峰-峰HR(ΔHR)、SBP变化(ΔSBP)和自觉症状。以ΔHR≥20次/min、ΔSBP≥2kPa或有心慌、头晕为阳性循环反应。结果①SA前后静注TD后SBP和HR均明显增高(P<0.01)，但硬膜外TD无明显变化(P>0.05)。②SA前和SA中比较，ΔHR、ΔSBP和阳性循环反应率差异无显著性(P>0.05)。③SA后静注TD时，ΔHR和ΔSBP与SA最大平面均无明显相关(rs分别为0.316和0.057，P>0.05)。结论CSEA时SA作用并不影响TD判断注入血管的准确性。
, 百拇医药
分类号：R614.4+2 文献标识码：A
The Efficacy of Epidural Test Doses during Combined Spinal-Epidural Anaesthesia
Huang Kechang ,YinYushui ,Zheng Jijian
(Department of Anaesthesiology,Affiliated Hospital of Weifang Medical College，Weifang，261031)
Abstract：Objective To determine the effect of spinal anesthesia(SA)during combined spinal-epidural(CSEA)on the efficacy of epinephrine test dose(TD)for the detection of uninteneional intravascular injection.Method Twenty-five patients were received CSEA.TDs(epinephrine 15ug in 2%lidocaine 3ml)were injected intravenously before and 30～40min after SA and epidurally after SA.After SA,intravenous and epidural injection were randomjed,cross-over with 10-minute interval.The maxinum cephalad levels of SA as well as peak-to-peak HR(ΔHR),changes of SBP(ΔSBP),the symptoms after injection of TDs were observed.Positive hemodynamic criteria were defined as ΔHR≥20 bpm，or ΔSBP≥2.0kPa，or appearance of such symptom as palpation and dizziness.Result Intravenous TD increased HR and SBP both before and after SA didn’t(P<0.01)，where as epidural TD after SA did not(P>0.05).The hemodynamic responses of intravenous TD before and after SA were found between the ΔHR or ΔSBP of intravenous TD and the level of anesthesia(rs＝0.316 and 0.057,respectively,P>0.05).Conclusion The presence of SA does not affect the efficacy of epinephrine TD for the detection of unintentionally intravenous injection by posnitive hemodynamic criteria during CSEA.
, 百拇医药
Keywords：Anaesthesia,spinal;Anaesthesia,epidural;Test doses;Epinephrine
参考文献：
[1]Smedstau KG.Controversies in obstetric anaesthesia[J].Can J Anaesth,1989,36:20
[2]黄科昌，黄雪琦，李生德.硬膜外试验剂量在老年人麻醉中的可靠性[J]，临床麻醉学杂志，1993，9：156
[3]Carpenter RL,Caplan RA,Brown DL,et al.Incidence and risk factors for side effects of spinal anaesthesia[J].Anesthesiology,1992,76:906
, 百拇医药
[4]Liu SS.Hemodynamic responses to an epidural epinephrine test dose in adults during epidural or combined epidural-general anaesthesia[J].Anesth Analg,1996,83:97
[5]Liu SS,Steves RA,Vasquez J,et al.The efficacy of epinephrine test dose during spinal anesthesia in volenteers:Implications for combined spinal-epidural anesthesia[J].Anesth Analg,1997,84:780
[6]Stevens RA,Frey K,Liu SS,et al.Sympathetic block during spinal anesthesia in volunteers using lidocaine,tetracaine,and bupivacaine[J].Reg Anesth,1997,22:325
, 百拇医药
[7]Stevens RA,Beardsley D,White JL,et al.Dose spinal anesthesia result in a more complete sympathetic block than that from epidural block anesthesia[J]？Anesthesiology,1995,82:877
[8]Critchley LA,Short TG,Gin T.Hypotension during subarachnoid anesthesia:haemodynamic analysis of three treatments[J].Br J Anaesth,1994,72:151
收稿日期：1999-04-09, 百拇医药
单位：潍坊医学院附属医院麻醉科 潍坊 261031
关键词：麻醉；脊髓；麻醉；硬膜外；试验剂量；肾上腺素
潍坊医学院000123摘 要：目的观察脊麻硬膜外联合麻醉(CSEA)时脊麻(SA)作用是否影响含肾上腺素硬膜外试验剂量(TD)的有效性。方法25例CSEA病人，静脉或硬膜外注射2%利多卡因3ml(含肾上腺素15ug)。SA前仅静注，SA后30～40min时先后随机交叉间隔10min静脉和硬膜外注药。观察SA最大平面和注药后峰-峰HR(ΔHR)、SBP变化(ΔSBP)和自觉症状。以ΔHR≥20次/min、ΔSBP≥2kPa或有心慌、头晕为阳性循环反应。结果①SA前后静注TD后SBP和HR均明显增高(P<0.01)，但硬膜外TD无明显变化(P>0.05)。②SA前和SA中比较，ΔHR、ΔSBP和阳性循环反应率差异无显著性(P>0.05)。③SA后静注TD时，ΔHR和ΔSBP与SA最大平面均无明显相关(rs分别为0.316和0.057，P>0.05)。结论CSEA时SA作用并不影响TD判断注入血管的准确性。
, 百拇医药
分类号：R614.4+2 文献标识码：A
The Efficacy of Epidural Test Doses during Combined Spinal-Epidural Anaesthesia
Huang Kechang ,YinYushui ,Zheng Jijian
(Department of Anaesthesiology,Affiliated Hospital of Weifang Medical College，Weifang，261031)
Abstract：Objective To determine the effect of spinal anesthesia(SA)during combined spinal-epidural(CSEA)on the efficacy of epinephrine test dose(TD)for the detection of uninteneional intravascular injection.Method Twenty-five patients were received CSEA.TDs(epinephrine 15ug in 2%lidocaine 3ml)were injected intravenously before and 30～40min after SA and epidurally after SA.After SA,intravenous and epidural injection were randomjed,cross-over with 10-minute interval.The maxinum cephalad levels of SA as well as peak-to-peak HR(ΔHR),changes of SBP(ΔSBP),the symptoms after injection of TDs were observed.Positive hemodynamic criteria were defined as ΔHR≥20 bpm，or ΔSBP≥2.0kPa，or appearance of such symptom as palpation and dizziness.Result Intravenous TD increased HR and SBP both before and after SA didn’t(P<0.01)，where as epidural TD after SA did not(P>0.05).The hemodynamic responses of intravenous TD before and after SA were found between the ΔHR or ΔSBP of intravenous TD and the level of anesthesia(rs＝0.316 and 0.057,respectively,P>0.05).Conclusion The presence of SA does not affect the efficacy of epinephrine TD for the detection of unintentionally intravenous injection by posnitive hemodynamic criteria during CSEA.
, 百拇医药
Keywords：Anaesthesia,spinal;Anaesthesia,epidural;Test doses;Epinephrine
参考文献：
[1]Smedstau KG.Controversies in obstetric anaesthesia[J].Can J Anaesth,1989,36:20
[2]黄科昌，黄雪琦，李生德.硬膜外试验剂量在老年人麻醉中的可靠性[J]，临床麻醉学杂志，1993，9：156
[3]Carpenter RL,Caplan RA,Brown DL,et al.Incidence and risk factors for side effects of spinal anaesthesia[J].Anesthesiology,1992,76:906
, 百拇医药
[4]Liu SS.Hemodynamic responses to an epidural epinephrine test dose in adults during epidural or combined epidural-general anaesthesia[J].Anesth Analg,1996,83:97
[5]Liu SS,Steves RA,Vasquez J,et al.The efficacy of epinephrine test dose during spinal anesthesia in volenteers:Implications for combined spinal-epidural anesthesia[J].Anesth Analg,1997,84:780
[6]Stevens RA,Frey K,Liu SS,et al.Sympathetic block during spinal anesthesia in volunteers using lidocaine,tetracaine,and bupivacaine[J].Reg Anesth,1997,22:325
, 百拇医药
[7]Stevens RA,Beardsley D,White JL,et al.Dose spinal anesthesia result in a more complete sympathetic block than that from epidural block anesthesia[J]？Anesthesiology,1995,82:877
[8]Critchley LA,Short TG,Gin T.Hypotension during subarachnoid anesthesia:haemodynamic analysis of three treatments[J].Br J Anaesth,1994,72:151
收稿日期：1999-04-09, 百拇医药