简易“针内针”方法蛛网膜下腔穿刺的临床应用

叶洁; 石金英

doi:10.13898/j.cnki.issn.1000-2200.2016.09.017

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简易“针内针”方法蛛网膜下腔穿刺的临床应用

叶洁 , 石金英

文章导航 > 蚌埠医学院学报 > 2016, 41 > 9: (1170-1172)

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简易“针内针”方法蛛网膜下腔穿刺的临床应用

叶洁,
石金英

安徽省芜湖市中医医院麻醉科, 241001

作者简介: 叶洁(1976-),女,副主任医师.

中图分类号: R614.41

Clinical application of the simple “needle in needle” technique in spinal puncture

Department of Anesthesiology, The Wuhu Hospital of Traditional Chinese Medicine, Wuhu Anhui 241001, China
CLC number: R614.41

摘要: 目的：探讨简易“针内针”水平法行蛛网膜下腔阻滞（腰麻）的可行性与效果。方法：择期行下肢及会阴手术患者40例，随机分为腰硬联合穿刺组（对照组）和9号皮针导引针内针腰麻穿刺组（观察组），各20例。2组均在L₃与L₄间隙行蛛网膜下腔穿刺，成功后注入0.75%布比卡因2 mL。对照组用16号硬膜外针先行硬膜外穿刺，后用5号腰硬联合针行蛛网膜下腔穿刺；观察组用9号皮针引导，直接用5号腰硬联合针行蛛网膜下腔穿刺。所有引导针的针尖斜面均与脊柱轴线平行，观察2组腰麻穿刺成功率、黄韧带和硬脊膜突破感知率、神经阻滞效果及术后头痛、腰痛、穿刺点痛发生情况。结果：观察组穿刺时间与对照组的差异无统计学意义（P>0.05）；2组细腰针突破硬脊膜时均有确切的纸质破裂感或阻力落空感差异无统计学意义（P>0.05）；2组穿刺成功率均为95%；2组感觉阻滞平面、感觉阻滞起效时间和运动神经阻滞起效时间差异均无统计学意义（P>0.05）。术后随访：2组皆无体位性头痛发生，但观察组术后第5天和第7天穿刺点痛和腰痛发生率均低于对照组（P<0.01）。结论：9号皮针引导“针内针”水平法腰穿可以确切感知突破硬脊膜，脑脊液流出通畅，腰麻麻醉效果确切，术后穿刺点疼痛及腰痛发生率低。
- 麻醉,脊髓 /
- 针内针 /
- 引导针 /
- 水平法
Abstract: Objective: To explore the feasibility and effects of the simple "needle in needle" technique in spinal puncture.Methods: Forty patients scheduled by lower extremity and perineum operation were randomly divided into the combined spinal-epidural puncture group(control group) and "needle in needle" guided by size 9 skin needle group(observation group)(20 cases each group).Two groups were punctured between L₃ and L₄ line,and injected with 0.75% bupivacaine for 2 mL.The control group were punctured using the size 16 epidural needle into epidural space,then the size 5 spinal-epidural needle was used to puncture into subarachnoid space.The observation group were punctured using the size 5 spinal-epidural needle combined with "needle in needle" guided by the size 9 skin needle.The bevel of the needle tip was parallel to the axis of the spine.The spinal anesthesia puncture success rate,feel rate of breaking the ligamentum flava and endorachis,effects of nerve block,postoperative headache,lumbago and puncture point ache in two groups were observed.Results: The puncturing time in observation group and control group were not statistically significant(P>0.05).The difference of the breakthrough and fall feeling at the time of breaking endorhachis between two groups was not statistically significant(P>0.05).The success rates of anesthesia in two groups were 95%.The differences of the sensory block plane,onset time of sensory block and motor block between two groups were not statistically significant(P>0.05).The postural headache was not found in two groups,but 5 and 7 days after surgery the incidences of the postoperative puncture point ache and lumbago in observation group were lower than those in control group(P<0.01).Conclusions: The application of the "needle in needle" guided by the size 9 skin needle during lumbar puncture can exactly feel the breakthrough of endorhachis,the cerebrospinal fluid flows smoothly,the effect is good,the incidence of postoperative puncture point ache and lumbago are low.
- anesthesia,spinal cord /
- needle in needle /
- spine cord /
- guidance needle

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简易“针内针”方法蛛网膜下腔穿刺的临床应用

叶洁
石金英

作者简介: 叶洁(1976-),女,副主任医师.

安徽省芜湖市中医医院麻醉科, 241001

收稿日期: 2015-08-31

关键词:

摘要: 目的：探讨简易“针内针”水平法行蛛网膜下腔阻滞（腰麻）的可行性与效果。方法：择期行下肢及会阴手术患者40例，随机分为腰硬联合穿刺组（对照组）和9号皮针导引针内针腰麻穿刺组（观察组），各20例。2组均在L₃与L₄间隙行蛛网膜下腔穿刺，成功后注入0.75%布比卡因2 mL。对照组用16号硬膜外针先行硬膜外穿刺，后用5号腰硬联合针行蛛网膜下腔穿刺；观察组用9号皮针引导，直接用5号腰硬联合针行蛛网膜下腔穿刺。所有引导针的针尖斜面均与脊柱轴线平行，观察2组腰麻穿刺成功率、黄韧带和硬脊膜突破感知率、神经阻滞效果及术后头痛、腰痛、穿刺点痛发生情况。结果：观察组穿刺时间与对照组的差异无统计学意义（P>0.05）；2组细腰针突破硬脊膜时均有确切的纸质破裂感或阻力落空感差异无统计学意义（P>0.05）；2组穿刺成功率均为95%；2组感觉阻滞平面、感觉阻滞起效时间和运动神经阻滞起效时间差异均无统计学意义（P>0.05）。术后随访：2组皆无体位性头痛发生，但观察组术后第5天和第7天穿刺点痛和腰痛发生率均低于对照组（P<0.01）。结论：9号皮针引导“针内针”水平法腰穿可以确切感知突破硬脊膜，脑脊液流出通畅，腰麻麻醉效果确切，术后穿刺点疼痛及腰痛发生率低。

English Abstract

Clinical application of the simple “needle in needle” technique in spinal puncture

Department of Anesthesiology, The Wuhu Hospital of Traditional Chinese Medicine, Wuhu Anhui 241001, China

Received Date: 2015-08-31

Abstract: Objective: To explore the feasibility and effects of the simple "needle in needle" technique in spinal puncture.Methods: Forty patients scheduled by lower extremity and perineum operation were randomly divided into the combined spinal-epidural puncture group(control group) and "needle in needle" guided by size 9 skin needle group(observation group)(20 cases each group).Two groups were punctured between L₃ and L₄ line,and injected with 0.75% bupivacaine for 2 mL.The control group were punctured using the size 16 epidural needle into epidural space,then the size 5 spinal-epidural needle was used to puncture into subarachnoid space.The observation group were punctured using the size 5 spinal-epidural needle combined with "needle in needle" guided by the size 9 skin needle.The bevel of the needle tip was parallel to the axis of the spine.The spinal anesthesia puncture success rate,feel rate of breaking the ligamentum flava and endorachis,effects of nerve block,postoperative headache,lumbago and puncture point ache in two groups were observed.Results: The puncturing time in observation group and control group were not statistically significant(P>0.05).The difference of the breakthrough and fall feeling at the time of breaking endorhachis between two groups was not statistically significant(P>0.05).The success rates of anesthesia in two groups were 95%.The differences of the sensory block plane,onset time of sensory block and motor block between two groups were not statistically significant(P>0.05).The postural headache was not found in two groups,but 5 and 7 days after surgery the incidences of the postoperative puncture point ache and lumbago in observation group were lower than those in control group(P<0.01).Conclusions: The application of the "needle in needle" guided by the size 9 skin needle during lumbar puncture can exactly feel the breakthrough of endorhachis,the cerebrospinal fluid flows smoothly,the effect is good,the incidence of postoperative puncture point ache and lumbago are low.