等比重与重比重局麻药在腰麻中的临床应用

Isobaric and hyperbaric local anesthetic used in spinal anesthesia

目的:比较等比重与重比重局麻药在腰麻中临床应用的优缺点,为低位手术麻醉提供参考。方法:选择ASAⅠ～Ⅱ级的拟行短时间(≤3h)下腹部手术病例160例,随机分为等比重组(Ⅰ组,80例)和重比重组(H组,80例),用联合腰麻硬膜外麻醉(CSEA)技术的针内针法经L2～3实施腰麻,均采用0.5%布比卡因3mL,比较2组患者围术期血流动力学变化及注药后病人的反应、麻醉起效及消退时间、感觉阻滞的峰平面等。结果:2组均取得良好的麻醉效果。2组病人麻醉起效时间相近。与I组相比,H组病例感觉阻滞达峰平面较I组快,且峰平面较I组高(阻滞节段数较多),感觉阻滞平面下降2节段的时间较I组短,伤口疼痛出现较I组早(P<0.01),运动阻滞消退较I组快(P<0.05),自解小便功能恢复较I组晚(P<0.01)。结论:等比重局麻药较重比局麻药在腰麻中具有明显的优越性。

Objective To reveal the advantages and disadvantages of the application of isobaric and hyperbaric local anesthetic in spinal anesthesia so as to provide reference for clinical practice. Methods One hundred and sixty ASA patients (physical status I～Ⅱ) undergoing lower abdominal surgery within 3 hours under spinal anesthesia (using CSEA technique via spinal needle in epidural needle) were allocated to 2 groups with 80 cases each. In lateral decubitus, patients randomly received a subarachnoid injection of 3.0mL (15mg) isobaric (Group I) or hyperbaric (Group H) bupivacaine and then turned supine. Hemodynamic changes and patients’ responses were perioperatively observed. After subarachnoid injection,we recorded the time of onset and motor block, the peak sensory blocked level, the time of regression of 2 dermatomes, the time of the first administration of analgesics for a significant pain of the incision, the time of the regression of motor block to modified Bromage scale 2, and the time of recuperating the function of urination. Results Both isobaric and hyperbaric 0.5% bupivacaine solutions in a volume of 3.0mL provided effective sensory and motor block for the operations. The time of onset and complete motor block were similar in the two groups. Compared with Group I, the time of peak sensory block in Group H was shorter, the peak sensory block level was higher (more maximal dermatomes of blocked sensory nerves), the time of regression of sensory and motor block were shorter, the time of recuperating the function of urination was longer, and the incidence of feeling sick, nausea, vomiting and hypotension was higher. Conclusion Isobaric solution is superior to hyperbaric solution in spinal anesthesia.