两种防治腰硬联合麻醉后神经根损伤方法的疗效比较

目的探讨防治下腹部与下肢手术腰硬联合麻醉后神经根损伤的最佳方法。方法87例腰硬联合麻醉过程中出现神经根刺激症状即为神经根损伤的手术患者，随机分为两组：Ⅰ组手术结束后甲钴胺序贯疗法：注射用甲钴胺0．5mg加入生理盐水250mL静滴，每日1次，7d后改为口服甲钴胺片0．5mg，每日3次，共15d；Ⅱ组手术结束前，硬膜外腔注入地塞米松5mg＋维生素B12 0．5mg＋生理盐水3mL复合液防治。观察麻醉消退后皮肤感觉障碍的情况和发生时间；评价药物疗效；观察出院时患者对神经根损伤后遗症的担忧情况。结果Ⅰ、Ⅱ组防治有效率分别为71．4％与93.3％，神经根并发症发生率分别为28．6％与6．7％，差异有统计学意义（P〈0．05）。Ⅱ组担忧人数少于Ⅰ组（P〈0．05）。结论硬膜外及时应用地塞米松与维生素B12复合液能减少术后神经根损伤并发症的发生率。

Curative Effect Comprison between Two Ways to Prevent and Cure Nerve Root Injury Caused by the Combined Spinal-epidural Anesthesia

Objective To find out the better way to prevent and cure nerve root injury caused by the combined spinal-epidural anesthesia （CSEA）. Methods Eighty-seven patients suffered from the nerve root injury, which means one had a nerve root irritation symptom during CSEA, were divided into two groups randomly. Group Ⅰ was treated by mecobalamin sequential therapy after surgery： 250mL normal saline added with 0.5mg injectable mecobalamin was infused through vein once daily. 7 days later, it was replaced by the oral medication of 0.5mg mecobalamin tablets three times daily. Group Ⅱ： The compound including 5mg dexamethasone, 0.5mg vitamin B12 and 3mL normal saline was injected into the epidural space before the surgery completed. To observe the time and situation of skin feeling deficiency after the anesthesia vanished;evaluate the efficacy of the two treatment methods, and the patients＇ concerns about consequences of the nerve root injury. Results The effective percent were 71.4% versus 93.3%（Group Ⅰ vs Group Ⅱ）, while the incidence rate of complication was 28.6% versus 6.7%（Group Ⅰ vs Group Ⅱ）, the differences between the two groups were significant （P〈0.05）. There were few patients who concern about consequences of the nerve root injury in Group Ⅱ （P〈0.05）. Conclusion The epidural injection of the compound including dexamethasone and vitamin B12 can significantly reduce the incidence of complications of the CSEA and concerns on nerve root injury.