改进法骶管阻滞麻醉体会(1)
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[摘要] 目的：比较两种骶管阻滞麻醉穿刺方法的麻醉效果。方法：选择择期行肛门、会阴部和直肠手术的患者120例，ASAⅠ～Ⅱ级，随机分为两组，每组60例。经典法组用经典的骶管阻滞穿刺方法，改进法组用改进的骶管穿刺方法，比较两组在进针深度、改麻醉的例数、穿刺失败的例数、术后尿潴留例数的差别。结果：进针深度上经典法组为2.5～3.5 cm，改进法组为0.3～0.5 cm(P<0.05)；在改麻醉例数上，经典法组为7例，改进法组为0例(P<0.05)；在穿刺失败例数上，经典法组为5例，改进法组为0例(P<0.05)；在术后尿潴留的例数上，经典法组为6例，改进法组为5例(P>0.05)。结论：在行骶管麻醉时采用改进的穿刺操作方法可以显著提高麻醉的成功率和麻醉的安全性。
[关键词] 骶管；麻醉；穿刺
[中图分类号] R614.4[文献标识码] A [文章编号] 1673-7210(2010)10(a)-070-02
Experience of improve the method in sacral block anaesthesia
XU Zhongdong
(Huaiyin Hospital, Jiangsu Province, Huaiyin 223300, China)
[Abstract] Objective: To compare the effect of two kinds of sacral block anaesthesia puncturing method. Methods: 120 patients with elective surgery of anal, perineum and rectum operation were selected, ASAⅠ-Ⅱ, and randomly divided into 2 groups, 60 cases in each group. The classical group was punctured with the classical sacral block, while the improving group with an improved one. Compared with the difference of puncture depth, changing anesthetization cases and puncture failure cases and postoperative urinary retention cases between 2 groups. Results: puncture depth was 2.5-3.5 cm in the classical group, with 0.3-0.5 cm in the improving group (P<0.05); Changing anesthetization cases was 7 cases in the classical group, with 0 case in the improving group (P<0.05); puncture failure cases was 5 cases in the classical group, with 0 case in the improving group (P<0.05); postoperative urinary retention cases was 6 cases in the classical group, with 5 cases in the improving group (P>0.05). Conclusion: The improving method in sacral block anaesthesia significantly improve the success rate of anesthesia and the safety of the anaesthesia.
[Key words] Sacral canal; Anesthesia; Puncture
骶管阻滞麻醉是经骶裂孔将局麻药注入骶管腔内以阻滞骶神经和尾神经，是硬膜处阻滞的一种，常用于肛门、会阴部和直肠手术。我院自2008年9月～2010年6月共施行改进法骶管阻滞麻醉60例，取得一定体会，并与同期施行的经典法骶管阻滞60例进行比较，现报道如下：
1 资料与方法
1.1 一般资料
120例患者中男74例(每组37例)，女46例(每组23例)，年龄18～64岁(改进法组18～64岁、经典组19～63岁)，ASAⅠ～Ⅱ级。复杂性肛瘘58例(每组29例)，混合痔24例(每组12例)，肛周脓肿17例(经典法组9例，改进法组8例)，直肠脱垂及直肠息肉11例(经典法组5例，改进法组6例)，阴道脱垂4例(每组2例)，尿道肉阜6例(每组3例)。两组患者在性别、年龄、所患疾病种类和病例数上比较无显著性差异。术前检查，所有患者心、肺、肝、肾、凝血及内分泌功能未见异常 ......
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