三种不同局麻药腰-硬联合麻醉在TVP中应用的效果比较

Comparison of Efficacy of Three Different Local Anesthetics for Combined Spinal and Epidural Anesthesia on the Application of TVP

[目的]比较三种不同局麻药腰-硬联合麻醉(CSEA)用于经尿道前列腺汽化电切术(TVP)患者的安全性和有效性。[方法]选择良性前列腺增生老年患者90例,在CSEA下实施TVP手术。按所用局麻药随机均分为三组,Ⅰ组左旋布比卡因15mg;Ⅱ组罗哌卡因15mg;Ⅲ组布比卡因15mg。比较三组感觉、运动阻滞及恢复的异同,并观察用药后的不良反应。[结果]三组患者麻醉镇痛优良率达100%,但罗哌卡因的镇痛起效时间、运动阻滞起效时间、最大阻滞时间、最大运动阻滞时间比左旋布卡因和布比卡因显著延长(P<0.05或P<0.01);麻醉持续时间、痛觉恢复时间、运动恢复时间比左旋布比卡因和布比卡因显著缩短(P<0.05或P<0.01);罗哌卡因最大Bromage评分明显优于左旋布卡因和布比卡因(P<0.01)。[结论]等比重小剂量罗哌卡因CSEA用于老年患者TVP手术是安全有效的,且不良反应少。

[Objective] To compare the effect and safety of 3 different local anesthetics for combined spinal-epidural anesthesia (CSEA) on transurethral electro-vapor resection of prostate (TVP).[Methods] 90 cases,schedule for TVP in CSEA,were randomly divided into 3 groups according to different local anesthetics.Group Ⅰlevobupivacaine;group Ⅱropivacaine;group Ⅲ bupivacaine.Compare the similarities and differences of 3 groups feeling,movement and restore from block,and observe the adverse reactions.[Results] Narcotic analgesic excellent rates of 3 groups were 100%,but the analgesic onset time,the sports block onset time,the largest block of time,the largest sports block of time were significantly longer in ropivacaine group than those in levobupivacaine and bupivacaine groups;Duration of anesthesia,pain recovery time,sports block recovery time in group Ⅱwere significantly shorter than those in groupⅠand group Ⅲ;The largest Bromage score in group ropivacaine was superior than that in group levobupivacaine and group bupivacaine.[Conclusion]Low-dose and isobaric ropivacaine for CSEA in elderly on TVP is safe and effective,with less adverse reactions.