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  【摘要】目的 探讨腰麻后即刻硬膜外腔注入与手术结束时注入右旋糖苷预防剖宫产术后头痛的临床效果。方法 选择正常足月孕妇100例，分为腰麻后即刻注入组(A组)和手术结束时注入组(B组)，每组各50例。腰麻后即刻注入组(A组)选择L3/4间隙行腰穿，进入蛛网膜下腔且见脑脊液流出后注入10℅葡萄糖1ml+0.75%布比卡因1.3ml,退出腰穿针约0.5㎝无脑脊液流出后注入右旋糖苷20 ml。手术结束时注入组(B组)，选择L3/4间隙行硬膜外穿刺，成功后经硬膜外穿刺针置入腰穿针，进入蛛网膜下腔且见脑脊液流出后注入10℅葡萄糖1ml+0.75℅布比卡因1.3 ml，退出腰穿针，置入硬膜外导管进入硬膜外腔约3.5㎝，手术结束时经硬膜外导管右旋糖苷20 ml。术后住院期间每天访视并记录产妇是否出现头痛。结果 A组术后头痛2例，发生率为4%。B组术后头痛3例，发生率为6℅。结论 腰麻后即刻硬膜外腔注入与手术结束时注入右旋糖苷均能够有效预防剖宫产术后头痛。

 【关键词】腰麻 硬膜外腔 右旋糖苷 剖宫产术 头痛

 中图分类号：R614 文献标识码：B 文章编号：1005-0515(2011)7-068-02

 Comparison the effects of post-lumber puncture headache after cesarean section by injecting dextran-40 into epidural space immediatly after spinal anesthesia and after operation

 Wang Chun

 (Department of Anesthesiology , 158 Hospital of PLA, Liuzhou ,China 545005)

 【Abstract】Objective To investigate the clinic effect of preventing post-lumber puncture headache after cesarean section by injecting dextran-40 into epidural space immediatly after spinal anesthesia and after operation. Methods One hundred ASAⅠpatients with fulltime pregnancies age ranged from 22-38 years and body weight from 50-85㎏ undergoing cesarean section were studied and divided into two groups of 50 patients: group A and B .In group A was injected dextran-40 20ml into epidural space immediate after spinal anesthesia and in group B was injected dextran-40 20ml by epidural catheter after operation.Headache was recorded and compared between two groups during admission. Results There was 2 headache cases in group A and 3 cases in group B . Occurrence frequency was 4﹪,6﹪respectively.There was no significant difference in headache occurrence frequency between two groups . Conclusion By injecting dextran-40 into epidural space immediatly after spinal anesthesia and after operation can prevent post-lumber puncture headache effectively.

 【Key Words】Spinal anesthesia Epidural space Dextran-40 Cesarean section;Headache

 腰麻以其起效快、效果确切、方法简便越来越广泛地应用于临床，但腰麻后头痛的出现又使其应用受到一定的限制，如何找到有效地预防腰麻后头痛的方法变得尤为迫切。本研究旨在探讨二种腰麻后经硬膜外腔注入右旋糖苷的方法对预防腰麻术后头痛的临床效果。

 1 资料与方法

 1.1 一般资料 选择正常足月孕妇100例,年龄22-38岁,平均30岁;体重50-85㎏，平均70㎏。排除合并妊高症、冠心病、内分泌系统疾病、精神心理性疾病 、头痛及其他合并脏器功能障碍的孕妇。100例中腰麻后即刻注入组(A组)和手术结束时注入组(B组)各50例。

 1.2 治疗方法 腰麻后即刻注入组(A组)选择L3/4间隙行腰穿，进入蛛网膜下腔且见脑脊液流出后注入10℅葡萄糖1ml+0.75℅布比卡因1.3 ml，退出腰穿针约0.5㎝无脑脊液流出后注入右旋糖苷20 ml。手术结束时注入组(B组)，选择L3/4间隙行硬膜外穿刺，成功后经硬膜外穿刺针置入腰穿针，进入蛛网膜下腔见脑脊液流出后注入10℅葡萄糖1ml+0.75布比卡因1.3 ml，退出腰穿针，置入硬膜外导管进入硬膜外腔约3.5㎝，手术结束时经硬膜外导管注入右旋糖苷20 ml。

 1.3 头痛的诊断标准 前额、枕部疼痛或弥漫性头痛，疼痛性质为钝痛或波动性疼痛，可伴有恶心、呕吐 、颈强直。其特点是：与体位相关，坐位和站立时出现，平卧时缓解。

 1.4 观察结果与指标 术后住院期间每天访视并记录产妇是否出现头痛。观察有头痛和无头痛二种结果，采用卡方检验进行统计学处理。同时观察血压、麻醉平面及麻黄碱用量情况并进行比较。

 1.5 统计学处理 计量资料用t检验，计数资料用卡方检验，P0.05)见表1。

 2.2 二组麻醉后3min 、5 min 血压均较麻醉前有明显降低(P0.05)见表3 ......