硬膜外腔注射生理盐水预防剖宫产腰穿后头痛的效果观察

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摘要目的观察硬膜外腔注射生理盐水预防腰硬联合麻醉下行剖宫产腰穿后头痛的效果。方法选取2013年5月～2014年5月在我院接受剖宫产的184例患者。采用随机数字表法，将患者分为对照组（C组）和研究组（R组），每组92例。两组均于腰硬联合麻醉下行剖宫产手术。C组在腰硬联合麻醉腰麻成功后直接放置硬膜外导管；R组在腰硬联合麻醉腰麻成功后立刻向硬膜外腔注射5 m1生理盐水才放置硬膜外导管。麻醉成功后，保持血流动力学稳定。术后均采用患者自控静脉镇痛。安返病房后均去枕平卧6 h，并随访患者5 d。记录两组术后发生头痛的例数；麻醉成功后，记录两组麻醉的最高阻滞平面、低血压发生率及需要应用麻黄碱提升血压的患者例数。结果与C组比较，R组的最高阻滞平面相对更高，差异有统计学意义（P＜0.05）。两组低血压发生率及需应用麻黄碱患者的比例差异无统计学意义（P＞0.05）。C组有7例患者在术后48 h内发生头痛，发生率为7.6%，R组则无一例患者发生头痛，两组头痛发生率差异有统计学意义（P＜0.05）。C组7例头痛患者中，6例经治疗后好转出院，1例出院后1个月余好转。结论剖宫产患者在腰硬联合麻醉腰麻成功后立刻向硬膜外腔注射生理盐水能较好地预防腰穿后头痛。

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关键词 ：腰穿后头痛, 剖宫产, 腰硬联合麻醉, 硬膜外腔, 生理盐水

Abstract：Objective To observe the effect of epidura1 injection of norma1 sa1ine via epidura1 space preventing post-1umbar puncture headache for caesarean section under combined spina1-epidura1 anesthesia. Methods From May 2013 to May 2014，184 patients undergone caesarean section in our hospita1 were se1ected.By a random number tab1e，they were even1y divided into contro1 group (group C) and research group (group R)，and there were 92 cases in each group. Caesarean section was imp1emented under combined spina1-epidura1 anesthesia in both groups.In group C，epidura1 catheter was direct1y imp1anted after the success of combined spina1-epidura1 anesthesia.In group R，5 m1 norma1 sa1ine was injected via epidura1 space right away after the success of combined spina1-epidura1 anesthesia，then epidura1 catheter was imp1anted.After the success of anesthesia，haemodynamics was maintained stab1e.Patient contro11ed intravenous ana1gesia was used after surgery.After patients were returned to the ward safe1y，and they were 1ying in horizonta1 position without pi11ow for 6 h，and patients were fo11owed up for 5 days.The number of headache after surgery in two groups was recorded，and after successfu1 anesthesia，the highest b1ock p1ane of anesthesia，occurrence rate of hypotension and cases of increasing b1ood pressure using ephedrine in two groups was recorded respective1y. Results Compared with group C，the highest b1ock p1ane of group R was re1ative1y higher，and the difference was statistica11y significant (P＜0.05).There was no statistica1 difference of occurrence rate of hypotension and proportion of patients using ephedrine between two groups (P＞0.05).In group C，7 patients had headache within 48 h after operation，the incidence rate was 7.6%，and there was no headache in group R，and there was a statistica1 difference of occurrence rate of headache between the two groups (P＜0.05).Among 7 patients with headache C group，6 patients were cured to become better to 1eave hospita1，1 case become better after more than 1 months 1eaving hospita1. Conclusion For patients with caesarean section，injection of norma1 sa1ine via epidura1 space right away after successfu1 combined spina1-epidura1 anesthesia can better prevent post-1umbar puncture headache.

Key words： Post-1umbar puncture headache Caesarean section Combined spina1 -epidura1 anesthesia Epidura1 space Norma1 sa1ine

作者简介: 王鹤（1976-），女，云南丽江人，麻醉学硕士，主治医师，擅长于危重患者、心血管病患者及妇产科患者的麻醉

引用本文:

王鹤;王文法. 硬膜外腔注射生理盐水预防剖宫产腰穿后头痛的效果观察[J]. 中国当代医药, 2016, 23(6): 49-52.
WANG He;WANG Wen-fa. Effect observation of ePidural injection of normal saline Preventing Postlumbar Puncture headache for caesarean section. 中国当代医药, 2016, 23(6): 49-52.

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