罗哌卡因经Spinocath导管行连续腰麻及PCA用于下腹部术的临床观察

Continuous spinal anesthesia and postoperative analgesia with ropivacaine by spinocath catheter for patients undergoing lower abdominal operation

目的观察罗哌卡因经Spinocath导管行连续腰麻(CSA)及术后自控镇痛(PCA)应用于下腹部手术的安全性和有效性。方法50例ASAⅠ-Ⅱ级拟行下腹部手术的患者,于L2～3间隙穿刺置入24GSpinocath连续腰麻导管,分次注入0.75%罗哌卡因2.5ml。术后PCA随机分为三组,A组(n=16):0.15%罗哌卡因;B组(n=16):0.125%罗哌卡因;C组(n=18):0.125%罗哌卡因+0.0002%芬太尼,容量均为60ml,三组背景输注速度1ml/h,PCA单次剂量0.5ml,时间锁定30min。观察术中HR、MAP、SpO2的变化,最高阻滞平面,运动阻滞程度(改良Bromage分级法),麻醉效果分级,PCA镇痛效果(视觉模拟评分法VAS)及不良反应和并发症。结果所有患者HR、MAP、SpO2均在正常范围内。最高阻滞平面为T7.2±0.9,改良Bromage评级均为Ⅲ级,麻醉效果满意率为96%。VAS评分A、C两组明显低于B组(P<0.01)。A组运动阻滞恢复时间较B、C两组明显延长(P<0.01)。结论下腹部手术中,采用罗哌卡因经Spinocath导管行连续腰麻及PCA,安全有效,具有可行性。

Objective To observe the safety and effect of continuous spinal anesthesia （CSA） and patient controlled analgesia （PCA） with ropivacaine by spinocath catheter for patients under-going lower abdominal operation. Methods Fifty ASA Ⅰ-Ⅱ patients scheduled for lower abdominal operation were chosen. They received 0.75 % ropivacaine for continuous spinal anesthesia by spinocath catheter that was placed at L2- 3, and a loading dose of 1.5 to 2.5 ml was given. All cases were randomly divided into 3 groups for postoperative analgesia： 16 cases in group A received 0.15 % ropivacaine, 16 cases in group B received 0. 125% ropivacaine and a mixture of 0. 125% ropivacaine ＋ 0. 0002% fentanyl was used for 18 cases in group C. Background infusion rate was at 1.0 ml/h,bolus dose 0.5 ml and lock-out interval 30 min. PCA was maintained for 50 h. HR, MAP and SpO2 were continuously monitored during surgery,and onset time and level of analgesia were recorded. VAS pain score and movement of lower extremities （modified Bromage score） were assessed. Results HR, MAP and SpO2 in 50 patients were in normal range. Modified Bromage scores were class Ⅲ . VAS scores in groups A and C were lower than those in group B （P〈0.01）. The recovery time of motor block in group A was obviously longer than that in groups B and C （P 〈0.01）. Conclusion Continuous spinal anesthesia and post-operative PCA with ropivacaine by spinocath catheter for patients undergoing lower abdominal operation is safe and effective.