不同浓度剂量罗哌卡因腰麻对排尿功能影响的临床观察

Clinical Research of Urination Effect of Spinal Anesthesia with Different Dose of Ropivacaine

目的观察不同剂量罗哌卡因腰麻对排尿功能的影响。方法择期肛门会阴部手术84例,顺序分为7组取不同浓度剂量的罗哌卡因(0.1%3mg、0.25%3mg、0.25%5mg、0.375%5mg、0.375%7.5mg、0.5%7.5mg、0.5%10mg)行腰麻。观察麻醉效果、平面、BP、HR、SpO2、Bromage评分、术后24h排尿功能(无障碍自动排尿、轻度障碍自行排尿、尿潴留)。结果全组麻醉镇痛、肌松满意,麻醉平面多在S1呈鞍状;BP、HR、SpO2无明显改变,Bromage评分多为0分,24h排尿功能无障碍52例(62%),轻度障碍17例(20%),尿潴留15例(18%),其中0.1%～0.375%3～5mg的1～4组尿潴留2例(4.2%),第7组0.5%10mg尿潴留7例(58%),两者比较差异有显著统计学意义(P<0.01)。结论0.1%～0.25%3～5mg重比重罗哌卡因腰麻用于肛门会阴部短小手术,足以满足手术要求,镇痛完全,肌松满意,麻醉平面局限,对BP、HR、SpO2几乎无影响,可显著减少麻醉因素对排尿功能的影响,值得采用。

Objective To observe the urination effect of spinal anesthesia with different dose of ropivaeaine. Methods A total of 84 cases of selective anal and perineal operation were chosen. They were divided into 7 groups with spinal anesthesia respectively with0.1% （3mg）,0.25% （3mg）, 0.25% （5mg）, 0.375% （5mg）, 0.375% （7.5mg）, 0.5% （7. 5mg） and 0. 5% （10mg） of hyperbaric ropivacaine. The anesthesia effect, level, blood pressure （BP）, heart rate （HR）, oxygen saturation ot pulse （ SpO2 ） , Bromage score and 24 - hour urination function were recorded. The urination function was classified from no dysuria to urinary retention. Results The anesthesia effects were satisfactory. The levels were most down to S1. BP, HR and SpO2 were stable. The Bromage scores were most at zero. There were 52 cases without dysuria, 17 eases with slight dysuria, and 15 eases with urinary retention, urinary retention were most common in 0.5 % （10mg） group. Conclusion It is suggested that 0.1% - 0.25% （3 -5mg） of hyperbaric ropivaeaine is satisfactory when applied to anal and perineal operation. Also, ropivacaine within the coneentration range almost brings about no adverse effect on urination function.