不同浓度容量的布比卡因对脊麻效应的研究

Effects of different concentration and volumes of bupivacaine on spinal anaesthesia for anal surgeries

目的 研究不同浓度与容量的布比卡因对肛肠手术脊麻效应的影响。方法 180例ASAⅠ～Ⅱ级接受肛肠手术患者 ,随机分三组 ,每组 6 0例。脊麻均选择L3～ 4间隙穿刺。Ⅰ组取坐位穿刺 ,用 0 75 %布比卡因 0 6ml;Ⅱ、Ⅲ组均取侧卧位穿刺 ,分别注入 0 1%布比卡因 5ml、4ml。结果 麻醉效果 :三组麻醉效果均满意 ,未加任何辅助药完成手术。麻醉起效、消退时间 ,各组间比较无差异 (P >0 0 5 )。阻滞平面 :Ⅰ组阻滞平面最低 (L5) ;Ⅱ组阻滞平面最高 (L2 ) ;Ⅲ组阻滞平面在L3 。Ⅱ、Ⅲ组与Ⅰ组比较差异显著 (P <0 0 1)。术后不良反应 :Ⅰ组头痛、头晕 12例 (2 0 % ) ,Ⅱ、Ⅲ组无头痛、头晕病例。尿潴留Ⅰ组 15例 (2 5 % ) ;Ⅱ组 3例(5 % ) ;Ⅲ组 1例 (1 6 7% ) ,Ⅱ、Ⅲ组与Ⅰ组比较差异显著 (P <0 0 1)。结论 在肛肠手术脊麻中 0 1%布比卡因 4ml比 0 75 %布比卡因 0 6ml不良反应如头痛、头昏、尿潴留等发生率明显低 ,术后可早期活动 。

Objective To study the anesthetic effects of different concentration and volumes of bupivacaine on spinal anaesthesia for anal surgeries.Methods A total of 180 patients(ASA Ⅰ～Ⅱ,age 35～62,male/female=94/88) were randomly and evenly divided into three groups,i.e. groups Ⅰ～Ⅲ.The spinal anaesthesia was given between L_3 and L_4 intervertebral space in all the patients.Patients in Group Ⅰ were kept in sitting position during the operation and were given 0.75% bupivacaine 0.6ml with 10% GS 0.2ml in 15 seconds.Patients in groups Ⅱ and Ⅲ were kept in side-lying position and 0.1% bupivacaine 5ml and 4ml were given respectively in 50 seconds.Results (1)Satisfying anesthesia effects were observed in all the patients.(2)There were no differences in both anaesthesia onset time and duration in the three groups(P>0.05).(3)The highest block level was found in group Ⅱ(L_2);while lowest level,in group Ⅰ(L_5);in group Ⅲ,it was between them(L_3)(P<0.01).(4)No differences were found among the three groups in blood pressures and heart rates either before or after lumbar block(P>0.05).(5)12(20%).Headache and dizziness were observed in group Ⅰ after operations,but none in group Ⅱ and Ⅲ.Urinary retention occurred in 15(25%) cases in group Ⅰ,6(10%) cases in group Ⅱ and 2(3.3%) cases in group Ⅲ(P<0.01).Conclusion Low concentration bupivacaine(0.1%,4ml) for spinal anaesthesia is effective.