A RETROSPECTIVE SURVEY OF NEUROLOGICAL COMPLICATIONS OF INTRATHECAL ANESTHESIA AT 64 HOSPITALS IN GUANGXI

The preliminary analysis on the usage of intrathecal anesthesia and the incidence and rehabilitation rates of neurological complications after intrathecal anesthesia in 64 hospitals in Guangxi. To accumulate the clinical experience of intrathecal anesthesia and epidemiology data of neurological complications after intrathecal anesthesia. From 2008 to 2012, there is the most commonly used in CSEA, but also showed an increasing trend. Followed by EA, EA showed a downward trend. SA is used the least. The incidence of neurological complications after intrathecal anesthesia was 0.0408%, the incidence of neurological complications of EA, CSEA and SA were 0.0201%, 0.0552%, 0.049%, respectively (P﹤0.05). The incidence of three anesthesia neurological complication were compared, the difference was statistically significant (P = 0.000), the incidence of neurological complication after EA was the least, CESA was the most. There are statistically significant difference between the incidence of neurological complication of the two kinds grade hospital (P﹤0.05), the incidence of neurological complications in large and comprehensive hospital was more than that of non-large and comprehensive hospital , the odds ratio(OR) was 0.589 (95% CI:0.442~ 0.786 ). The incidence of TNS was the most, 0.0340%, followed by radicular damage (0.005%), the other three types of complications were relatively rare, 0.0008%, 0.0008%, 0.0002%, respectively. (P﹤0.05)The total cure rate of neurological complications was 89.8%, the cute rate of three kinds of anesthesia were 87.80%, 90.26%, 90.0% ,respectively, the difference was not statistically significant (P﹥0.05). All TNS patients were fully recovered (100%)，48% in radicular damage, 25% in cauda equina syndrome, the other two types complication of patients developed permanent damage. The total incidence of permanent neurological complication was 0.0042%. The incidence of permanent complications of EA ,CSEA and SA were 0.0034% ,0.0047% and 0.0049%（P﹥0.05）.

本研究针对广西64家医院的鞘内麻醉（intrathecal anesthesia）使用情况，以及鞘内麻醉后神经系统并发症的发生率与康复率开展初步分析，旨在积累鞘内麻醉的临床经验及相关流行病学数据。2008至2012年间，蛛网膜下腔-硬膜外联合麻醉（Combined Spinal-Epidural Anesthesia, CSEA）为最常用的麻醉方式，且使用量呈逐年上升趋势；其次为硬膜外麻醉（Epidural Anesthesia, EA），其使用率呈下降态势；蛛网膜下腔麻醉（Spinal Anesthesia, SA）的使用率最低。鞘内麻醉整体神经系统并发症发生率为0.0408%；其中EA、CSEA及SA对应的神经系统并发症发生率分别为0.0201%、0.0552%与0.049%，组间差异具有统计学意义（P<0.05）。三种麻醉方式的神经系统并发症发生率比较显示，组间差异具有显著统计学意义（P=0.000），其中EA组并发症发生率最低，CSEA组最高。不同等级医院的神经系统并发症发生率存在显著统计学差异（P<0.05）：大型综合医院的并发症发生率高于非大型综合医院，其比值比（odds ratio, OR）为0.589（95%置信区间：0.442~0.786）。神经系统并发症中以短暂性神经系统症状（Transient Neurological Symptoms, TNS）发生率最高，达0.0340%；其次为神经根损伤（0.005%）；其余三类并发症相对罕见，发生率分别为0.0008%、0.0008%与0.0002%，组间差异具有统计学意义（P<0.05）。神经系统并发症总体治愈率为89.8%；三种麻醉方式对应的并发症治愈率分别为87.80%、90.26%与90.0%，组间差异无统计学意义（P>0.05）。所有TNS患者均完全康复（康复率100%）；神经根损伤患者康复率为48%，马尾综合征（cauda equina syndrome）患者康复率为25%；其余两类并发症患者遗留永久性神经损伤。永久性神经系统并发症总发生率为0.0042%；EA、CSEA及SA对应的永久性并发症发生率分别为0.0034%、0.0047%与0.0049%，组间差异无统计学意义（P>0.05）