腰麻－硬膜外联合麻醉用于下腹部和下肢手术5526例体会

目的 观察腰麻-硬膜外联合麻醉用于下腹部、下肢手术时的麻醉效果及副作用。方法 选择近3年我院下腹部、下肢手术病人5526例，腰麻用药为0．375％布比卡因重比重或轻比重液，麻醉效果不足时经硬膜外导管追加1．5％利多卡因；术中连续监测呼吸循环状况，评价麻醉效果。结果 腰麻后阻滞平面满足手术要求的时间平均不到lOmin，下肢运动阻滞可达BromageⅢ级；麻醉成功率为98．5％，术后头痛发生率为0．23％，与其它各科相比产科病人麻醉后低血压发生率高，出现时间早，而70岁以上老年人低血压发生率与70岁以下病人相比无显性差异。结论 腰麻一硬膜外联合麻醉起效快、作用完善可靠、副作用少，用于下腹部、下肢手术无严格年龄界限，但剖腹产病人要采取适当措施，慎防麻醉后低血压发生。

The comprehension of lumbar anesthesia combining epidural space block anesthesia in 5526 cases of lower abdomen and lower limb operation

Objective To observe the anesthesia effect and side-effect of lumbar anesthesia combining epidural space block anesthesia(LACESBA)in lower abdomen and lower limb operation. Methods 5526cases of lower abdomen and lower limb operation in last3year in our hospital were selected to use LACESBA.Drug of lumbar anesthesia was0.375%bupivacaine high density liquid or lowdensity liquid.1.5%bupivacaine was given through epidural catheter when anesthesia effect was not good.Respiration and circulation condition were monitored continuous and anesthesia effect was evaluated. Results The time of block plan satisfying operative demand in lumbar anesthesia was no more than10minute averagely.Lower limb moving block could reach Brogame grade III.Anesthesia success ratio was98.5%,and headache incidence postoperative was0.23%.As compared to other department patients,hypotension incidence after anesthesia in obstetrics patients was higher and hypotension manifested earlier.But hypotension incidence after anesthesia in patients age above70had not significant difference compared with those in patients age blow70. Conclusion LACESBA had many virtue such as coming into effect quickly,good and credible anesthesia effect,less side-effect and no age limit in lower abdomen and lower limb operation.But hypotension after anesthesia should be avoided in cesarean patients