小剂量舒芬太尼混合布比卡因腰麻在经尿道前列腺切除术中的应用

Spinal anesthesia with low dose sufentanil-bupivacaine in transurethral resection of the prostate

目的:观察小剂量的舒芬太尼复合布比卡因腰麻在前列腺电切术应用中的麻醉效果和不良反应。方法:90例ASAⅠ~Ⅲ级择期经尿道前列腺切除术(transurethralresectionoftheprostate,TURP)患者随机分为A,B,C组,每组30例。A组:布比卡因7.5mg+舒芬太尼5μg+10%葡萄糖溶液;B组:布比卡因7.5mg+舒芬太尼7.5μg+10%葡萄糖溶液;C组:布比卡因15mg+10%葡萄糖溶液,三者的容量均为3mL。观察3组用药后的收缩压(SP)/舒张压(DP)、脉搏血氧饱和度(SpO2)、心率(HR)、运动和感觉阻滞程度及不良反应。结果:C组SP/DP比A组、B组下降显著(P<0.05);而在注药后15min左右,B组的HR和SpO2有不同程度的降低(P<0.05)。C组的运动和感觉神经阻滞持续时间较长且程度较重(P<0.05)。3组的镇痛效果相比差异无统计学意义,A组、B组瘙痒发生率高于C组。结论:小剂量舒芬太尼复合布比卡因腰麻对患者血液动力学影响小,运动和感觉阻滞程度轻,术后患者能及早运动,不良反应少。

Objective To explore the clinical efficacy of intrathecally administered low dose sufentanil-bupivacaine in transurethral resection of the prostate （TURP）. Methods Ninety patients （ ASA Ⅰ - Ⅲ ） undergoing TURP were randomly divided into 3 groups （ n = 30 ） ： Group A, B and C. Group A received 7.5 mg bupivacaine ＋ 5 p^g sufentanil ＋ 10 % glucose ; Group B received 7.5 mg bupivacalne ＋ 7.5 μg sufentanil ＋ 10% glucose ; Group C received 15 mg bupivacaine ＋ 10 % glucose. The volume was 3 mL in every group. SP, DP, HR, SpO2 , the degree of motor and sensory blockade and the side effect were observed. Results SP/DP was significantly decreased in Group C than that in Group A and Group B （ P 〈 0.05 ） , HR and SpO2 in Group B were decreased to different degrees 15 min after the injection （ P 〈 0.05 ） . The complete recovery time of motor nerve blockade and the regression time of sensory blockade were obviously prolonged in Group C （P 〈 0.05 ）. There were no significant differences in analgesic effect among the three groups during the operation, but the incidence of pruritus was higher in both Group A and Group B than that in Group C during the first 24 hours after the injection. Conclusion Spinal anesthesia with low dose sufentanilbupivacaine possesses relatively steady hemodynamics. The blockade degree of motor and sensory blockade in this spinal anesthesia is lower than that in standard spinal bupivacaine in TURP.