单侧蛛网膜下腔阻滞麻醉在下肢手术中的应用

Application of unilateral subarachnoid anesthesia in inferior extremity operation

目的比较单侧蛛网膜下腔阻滞麻醉与常规蛛网膜下腔阻滞麻醉应用于下肢手术的效果及其对血流动力学的影响。方法选择下肢择期手术80例,随机分为两组,均采用侧卧位L3~4蛛网膜下腔阻滞麻醉。对照组(A组)用0.75%布比卡因2 ml(15 mg)加10%葡萄糖溶液1 ml稀释至3 ml后单次注射,注射速度1 ml/5 s,注药后立即改为平卧位。实验组(B组)使用药物及方法与对照组相同,仅于注射后保持原侧卧位15 min后方改为仰卧位。测定两组患侧阻滞平面并观察对侧肢体麻醉情况,以Bromage评分评定对侧肢体运动情况,观察比较两组注药前(T1)和注药5 min(T2)、15 min(T3)3、0 min(T4)时的收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏氧饱和度变化以及麻醉维持时间及术后尿潴留发生情况。结果两组均能达到满意的麻醉效果,A组T2、T3时段HR、SBP及DBP变化显著,B组则无明显变化,两组比较T3时段的HR、SBP及DBP有显著性差异(分别为t=3.060t、=-3.200、t=-3.428,P【0.01)。B组麻醉维持时间明显长于A组(χ2=2.051,P【0.05)。A、B两组术后尿潴留发生率分别为12.5%(5例)和7.5%(3例)。结论单侧蛛网膜下腔阻滞用于下肢手术麻醉效果满意,与常规蛛网膜下腔阻滞麻醉比较,对血流动力学的影响较小、维持时间长,对术前患有较多并发症且手术时间较长的患者可能更有利。

Objective To compare the effect of anaesthesia and hemodynamic change in inferior extremity operation by using unilateral subarachnoid anesthesia(SA) and bilateral subarachnoid anesthesia.Methods Eighty patients undergoing selective lower extremity operations were randomized into 2 equal groups,who received spinal block in L3-4.All patients were asked to lie on the compromised side for slow injection of hyperbaric bupivacaine solution(0.75% 15 mg,diluted to 3 ml with 10%.G.S.) at the rate of 1 ml/5 s through a 24-gauge needle.Group A shifted to a supine position the time just injection completed,and Group B maintained their position for 15 min before shifting to a supine position.The range of blockage in compromised limb was evaluated and the effect of anesthesia in uncompromised limb was scored according to Bromage scoring system.The changes in the heart rate(HR),blood pressure(BP) and SpO2 before SA(T1) and 5 min(T2),15 min(T3),30 min(T4) after SA were observed and recorded.The time of maintenance and postoperative urinary retention were compared.Results Satisfactory effects of anesthesia were achieved in all two groups.Statistical study showed that HR,SBP and DBP in group A at T1 and T2 changed significantly,while none in group B.Significant variation were presented at T3 between the two groups.The hemodynamic change in group B was milder than that in group A,and the time of maintenance was longer.No significant difference in the incidence of postoperative urinary retention were showed.Conclusions Compared with bilateral SA,unilateral SA shows mild impact on hemodynamics and maintained longer,which may adapt to patients with more co-morbid preoperative and longer surgical time.