硬膜外麻醉在硬膜外腔灌洗下PELD手术中的应用

摘要

Objective To summarize clinical reliability and security of epidural anesthesia for PELD. Method We reviewed anesthetic effect and side effects of 284 cases who received operation of PELD under different epidural anesthesia in last four years. Results In these cases,we found epidural anesthesia which met requirements of PELD. Selecting T12 -L1 or T11 -T12 as epidural puncture point was recom-mended by us,and the obtained blocking area could spare surgery of the target area on the nerve root and dural stimulation devices sense of pain,and ensure that other surgical operations without pain. Conclusion Epidural anesthesia can be as a good choice for PELD. However, the anesthetic plane shoud be controled over L3 ~L4 . and choose low concentrations of ropivacaine administration induced multiple small do-ses. Do not superaddition with Local anesthetics in operation. Intravenous sedation and analgesia auxiliary is not needed.%目的：总结硬膜外麻醉用于PELD手术的临床可靠性和安全性。方法：回顾4年来284例PELD手术选择不同硬膜外麻醉方法下的麻醉效果和术中并发症。结果：回顾的样本中，所有硬膜外麻醉均可满足手术基本无痛要求，硬膜外麻醉穿刺点选择T12~L1或T11~T12能较好地保留手术目标区域的神经根和硬膜囊对器械刺激产生胀痛感，并保证手术其他操作无疼痛感。结论：硬膜外麻醉可以作为PELD手术较好的麻醉选择，但要控制足侧感觉平面不低于L3~L4，并选择低浓度罗哌卡因多次小剂量给药方式诱导，术中不可追加麻醉药，无需静脉辅助镇静与镇痛。