罗比卡因复合不同剂量曲马多腰麻用于老年前列腺电切术的效果比较

Application of Ropivacaine Combined with Tramadol in Variable Doses for Lumber Anesthesia in Transurethral Prostatic Electroresection of the Aged

目的:观察小剂量罗比卡因复合不同剂量曲马多腰麻用于老年前列腺汽化电切术的有效性、安全性。方法:60例择期老年前列腺汽化电切术患者,ASAI^II级,随机分为3组;局麻药配方为:0.75%罗比卡因2mL+5%葡萄糖0.7mL+3%麻黄碱0.3mL混合,I组蛛网膜下腔注2mL+注射用水0.4mL,II组注2mL+注射用水0.2mL+曲马多10mg(0.2mL),III组注2mL+曲马多20mg(0.4mL)。3组均于L2~3穿刺行腰麻-硬膜外联合麻醉(CSEA)。记录并比较三组患者ECG、BP、HR、RR和sPO2变化情况及感觉、运动阻滞情况和并发症。结果:3组患者BP、HR、RR和sPO2变化与麻醉前相比差别无显著性意义(P>0.05)。感觉阻滞起效时间及最高平面无明显差异(P>0.05);维持时间III组>II组>1组差别有显著性意义(P<0.05)。运动阻滞时间及程度差别无显著意义(P>0.05)。恶心呕吐、头痛及神经系统后遗症等并发症3组比较差别无显著意义(P>0.05)。结论:小剂量罗比卡因(10mg)复合曲马多10mg或20mg腰麻用于老年前列腺汽化电切术能明显延长镇痛时间,改善麻醉效果;但不加重运动阻滞,且对患者呼吸循环干扰少。

Objective： To observe the safety and efficacy of ropivacaine combined with tramadol in variable doses for lumber anesthesia in the transurethral prostatic electroresection of the aged. Methods： Sixty ASA Ⅰ～Ⅱ patients prepared for undergoing elective transurethral vapo-resection of the prostate were randomly divided into three groups. The components of local anesthetics included 2mL of 0.75% ropivacaine, 0.7mL of 5% glucose and 0.3mL of 3% ephedrine. Group Ⅰ received 2mL plus distilled water 0.4mL, group Ⅱ received 2mL plus distilled water 0.2mL plus tramadol 10mg（0.2mL）, group Ⅲ received 2mL plus tramadol 20mg（0.4mL）. Spinal puncture was performed at L2～3 interspace. The changes of ECG、BP、HR、RR、sPO2, sensory and motor block, and complications were recorded. Results： There were no significant difference in the changes of BP、HR、RR、sPO2 and motor block and complications among the 3 groups. The time of sensory block in group Ⅲ was more than group Ⅱ, group Ⅱ more than group Ⅰ. Conclusion： Spinal ropivacaine combined with tramadol 10mg or 20mg in the transurethral vapo-resection of the prostate is safe and effective.