关键词: 麻醉，硬膜外;腰痛;地塞米松;脊痛

    摘 要:目的 对比观察术前、术毕硬膜外腔地塞米松对腰部硬膜外麻醉腰背痛的预防效果. 方法 选择ASAⅠ～Ⅱ级在腰部硬膜外麻醉下手术患者1200例，均分为4组，硬膜外腔首次量均为19mL利多卡因复合液.组Ⅰ∶20g·L-1 利多卡因18mL和9g·L-1 氯化钠注射液1mL;组Ⅱ:同组Ⅰ，同时静注地塞米松(Dexa)1mL(5mg);组Ⅲ:20g·L-1 利多卡因18mL加Dexa1mL(5mg);组Ⅳ:同组Ⅰ，但于术毕硬膜外腔注入7.5g·L-1 丁哌卡因5mL加Dexa1mL(5mg).此后全组患者按手术需要硬膜外腔注入5g·L-1 丁哌卡因5～8mL. 结果 术后前3d组Ⅰ，Ⅱ，Ⅲ和Ⅳ腰背痛发生率分别为24.7%，23.3%，8%和8.7%.组Ⅰ和组Ⅱ腰背痛发生率明显多于组Ⅲ和组Ⅳ(P<0.01)，且疼痛程度明显重于后两组，组Ⅰ和组Ⅱ或组Ⅲ和组Ⅳ间无明显差异(P>0.05).组Ⅰ，组Ⅱ硬膜外穿刺次数与术后腰背痛明显正相关(P<0.01);组Ⅲ，组Ⅳ腰背痛发生率及硬膜外穿刺次数与腰背痛无明显关系(P>0.05). 结论 硬膜外腔地塞米松有效预防腰部硬膜外麻醉后腰背痛，其疗效不受注药时机的影响.

    Effect of epidural dexamethasone administration on backache occurring after lumbar epidural anesthesia

    CHEN Guo-Zhong，DOU Yuan-Yuan，WANG Jing-Hua，YU Xiang-Hong，LIN Xiu-Zhen，ZENG Jian，CHEN Dong-Sheng

    Department of Anesthesiology，Fuzhou General Hospital of Chinese PLA，Nanjing Command，Fuzhou350025，China

    Keywords:anesthesia，epidural;low back pain;dexametha-sone;back pain

    Abstract:AIM To compare the effect of dexamethasone epidurally given pre-or postoperatively on backache occurring after lumbar epidural anesthesia.METHODS One thousand and two hundred patients of ASA physical statusⅠorⅡwho had undergone lower abdomen or lower limb operations were divided into four groups.GroupⅠreceived18mL lidocaine(20g·L-1 )and1mL normal saline epidurally ......