金峰 唐在荣 徐知菲

    [摘要] 目的 比较腰硬联合麻醉穿刺中旁正中入路与正中入路两种方法在高龄患者TURP手术中的优劣性。 方法 选择本院2019年1—10月择期行TURP手术患者100例，年龄65～85岁，ASAⅠ～Ⅲ 级，无椎管内麻醉相关禁忌证，随机分为正中入路组(M组)与旁正中入路组(P组)，每组各50例。两组患者均选择L4～5间隙，M组患者采用常规脊柱中正入路穿刺行腰硬联合椎管内阻滞;P组患者以旁正中入路即脊柱正中线下旁开1～1.5 cm穿刺置管行腰硬联合麻醉。观察记录两组患者麻醉穿刺操作成功率，重复穿刺及硬膜外导管置管失败例数;并观察两组患者穿刺与置管引起下肢感觉异常、硬膜导管置入血管及穿刺后7 d腰背部疼痛等不良反应。 结果 与M组比较，P组穿刺成功率明显高于M组(P<0.05);硬膜外置管失败、下肢感觉异常、硬膜外导管置入血管及患者术后腰背疼痛的发生率明显降低(P<0.05)。 结论 与传统正中穿刺入路相比，旁正中入路具有更高的脊髓麻醉穿刺成功率与更低的不良反应发生率，更适用于高龄TURP患者腰硬联合麻醉。

    [關键词] 腰硬联合麻醉;正中入路;旁正中入路;高龄;TURP

    [中图分类号] R614? ? ? ? ? [文献标识码] B? ? ? ? ? [文章编号] 1673-9701(2021)32-0137-03

    [Abstract] Objective To compare the advantages and disadvantages of two methods of combined spinal and epidural anesthesia puncture with paramedian approach and with median approach in transurethral resection of the prostate (TURP) in elderly patients. Methods A total of 100 patients of American Society of Anesthesiologists(ASA) grade Ⅰ-Ⅲ and without intraspinal anesthesia-related contraindications who aged 65-85 years and underwent elective TURP in our hospital from January to October 2019 were selected as the study subjects. They were randomly divided into the median approach group(group M) and the paramedian approach group (group P) ......