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      标题:局部及静脉联合用药超前镇痛对椎管内麻醉穿刺的影响
      作者:李中云,陆健君,杨焱焰,文建乾,牙 耀,刘文伟,甘立书
    (南宁市第三人民医院麻醉科,广西 南宁 530003)
      卷次: 2013年24卷4期
      【摘要】 目的 探讨局部及静脉联合用药超前镇痛对椎管内麻醉穿刺过程临床镇痛效果、麻醉体位配合的满意
度、麻醉穿刺一次成功率的影响。方法 择期行腹股沟疝修补术的患者80例,年龄36~60岁,体重48~75 kg,ASA分
级Ⅰ~Ⅱ级,采用随机数字表法,将其随机分为两组各40例。A组患者入室后立即在椎管内麻醉穿刺点为中心2 cm2
的皮肤范围内用2%利多卡因均匀的涂布两遍,开放静脉通路后静注地佐辛10 mg,C组穿刺点及静脉用等量生理盐
水。记录两组患者皮肤局麻进针时(T1)、椎管内麻醉穿刺过程(T2)的疼痛评分,麻醉穿刺时患者体位变动(体动),麻醉
穿刺一次成功率,患者满意度及不良反应(头晕、恶心、呕吐)。结果 与C组比较,A组在T1、T2的VAS评分明显降低
(P<0.05),患者体动明显减少(P<0.05),麻醉穿刺一次成功率明显增加(P<0.05),患者满意度高;两组患者恶心、呕吐
及头晕发生例数比较差异无统计学意义(P>0.05)。结论 局部及静脉联合用药超前镇痛对减轻患者椎管内麻醉穿
刺过程的紧张、焦虑及疼痛效果确切,体位配合好,麻醉穿刺一次成功率高,患者满意度高,有明显的临床意义。

      【关键词】 超前镇痛;椎管内麻醉;利多卡因;地佐辛

      【中图分类号】 R614.3 【文献标识码】 A 【文章编号】 1003—6350(2013)04—0512—02

Effect of preemptive analgesia with local and intravenous medication on intraspinal anesthesia puncture. LI
Zhong-yun, LU Jian-jun, YANG Yan-yan, WEN Jian-qian, YA Yao, LIU Wen-wei, GAN Li-shu. Department of
Anesthesiology, the Third People's Hospital of Nanning City, Nanning 530003,Guangxi, CHINA

      【Abstract】 Objective To investigate the effect of preemptive analgesia with local and intravenous medication on
the analgesic effect during puncture procedure, the degree of satisfaction for anesthesia puncture posture, and the one-time
success rate of anesthesia puncture. Methods Eighty patients of elective inguinal hernia (aged 36~60 years old, weighted
48~75 kg), classified as ASAⅠ~Ⅱ, were divided into the observation Group (group A, n=40) and the control group (C, n=
40) by a randomized single-blind method. Patients of group A were given 2% lidocaine twice immediately on the spinal an-
esthesia puncture point and 2 cm2 skin surface around, followed by injection of 10 mg Dezocine intravenously. Patients of
group C were given saline instead of lidocaine, followed by equal amount of saline solution injected intravenously. Pain
scores at the puncture of local anesthesia (T1) and during spinal anesthesia puncture procedure (T2), postural changes during
anesthesia puncture (movement), one-time success rate of anesthesia puncture, patient satisfaction and side effects (dizzi-
ness, nausea, vomiting) were recorded. Results Compared with group C, VAS scores of group A significantly decreased
at T1 and T2 (P<0.05), postural changes reduced significantly (P<0.05), the once-time success rate of anesthesia puncture in-
creased significantly (P<0.05), and the patient satisfaction was higher. No statistically significant difference was found be-
tween the two groups in side effects, including nausea, vomiting and dizziness (P>0.05). Conclusion Preemptive analge-
sia with local and intravenous medication is effective to relieve stress, anxiety and pain during spinal anesthesia, with good
body position, high one-time success rate, and high patient satisfaction.

      【Key words】 Preemptive analgesia; Spinal anesthesia; Lidocaine; Dezocine

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