不同剂量罗哌卡因腰-硬联合麻醉用于下肢手术的效果比较

Comparison on the effects between combined epidural-spinal anesthesia and different doses ropivacaine for lower limbs operation

目的比较不同剂量低浓度罗哌卡因腰-硬联合麻醉用于下肢手术的麻醉效果。方法择期下肢手术患者136例,急诊下肢手术患者83例。按腰麻用药分为0.1%、0.15%和0.2%罗哌卡因3组,每组73例,各组剂量从3mg开始递增,顺序完成3mg各3例,4mg各10例,5、6、7mg各20例。硬膜外腔维持用药均为0.2%罗哌卡因。术前不用药。患者侧卧位,患侧在上,L2-3套针法穿刺,调整麻醉平面在T9-10。观察麻醉效果,BP、HR、SpO2、Bromage评分等。结果优良率6-7mg时为95%、5mg时为50%-55%、4mg时为30%,剂量为3mg时虽有镇痛平面,但不能行手术,均为麻醉失败,剂量为7mg时无失败病例。患者术中BP、HR、SpO2平稳,无恶心呕吐。头痛1例,尿潴留2例。术中患肢Bromage评分为2-3分,健肢为0-1分。结论0.1%-0.2%罗哌卡因6-7mg腰麻与0.2%罗哌卡因硬膜外阻滞联合麻醉,具有用药少,起效快,镇痛完善,BP、HR、SpO2平稳,副作用小,麻醉消退快,能早期活动,利于搬运转移患者等优点,不仅可用于无严重创伤性休克患者下肢不同部位手术的麻醉,而且可为战时手术方舱内的手术提供一种麻醉选择。

Objective To compare the effects of combined epidural-spinal anesthesia and different doses ropivacaine anesthesia for the lower limb operations. Methods One hundred and thirty-six patients for elected operations and 83 emergency operation patients receiving lower limbs operations were enrolled for the comparative study. Patients receiving spinal analgesia were divided into 3 groups with 0.1%, 0.15% and 0.2% ropivacaine, respectively. The dosage was increased from 3mg to 7mg with 1mg increase stepwise for each group, and a total of 15 groups and 219 cases were studied with this regime. For the patients undergoing epidural block anesthesia, 0.2% ropivacaine was used. Patients were placed in lateral recumbent position with the affected limb on the top. Puncture was done at the level of L2-3 interspace with a fine trocar, keeping the anesthetic level at T9-10. The anesthetic effect, BP, HR, SpO2 and Bromage score were then recorded. Results The effective rate was 95% in 6mg and 7mg group, 50%-55% in 5mg group, and 30% in 4mg group. The dosage of 3mg failed to achieve anesthesia. There was no failure in 7mg groups. During the operations the BP, HR and SpO2 were stable. No nausea and vomiting occurred, except 1 patient complaining of headache and 2 patients with urine retention. The intraoperation Bromage score of the affected limbs were 2-3, and for the unaffected limbs it was 0-1. Conclusions It is suggested that 0.1-0.2% ropivacaine in a dosage of 6-7mg for spinal anesthesia combined with 0.2% ropivacaine for epidual block can be used in the limb operation. It overcomes many side effects of traditional lumbar anesthesia. This method may be of great advantage to patients with complete analgesia, less anesthetic agent used, earlier ambulation, stable circulation and respiration, and fewer side-effects.