等比重罗哌卡因蛛网膜下腔阻滞麻醉在肛肠手术的应用

Isobaric spinal anesthesia with 0.5% ropivacaine for anorectal surgery

目的探讨等比重罗哌卡因蛛网膜下腔阻滞麻醉（腰麻）用于肛门直肠手术的麻醉效果。方法ASAⅠ～Ⅱ级肛门直肠手术患者60例,随机法分成2组,分别采用0.5%布比卡因等比重（布比卡因组）和0.5%罗哌卡因等比重（罗哌卡因组）腰麻用于肛肠手术。观察比较2组患者围手术期血流动力学变化,腰麻后患者的感觉阻滞和运动阻滞的起效和持续时间、麻醉质量评价、低血压、恶心、呕吐、尿潴留等不良反应。结果与0.5%布比卡因等比重腰麻相比,0.5%罗哌布比卡因等比重腰麻感觉阻滞、运动阻滞起效时间较长,改良Bromage运动评分更高（P〈0.05）,感觉阻滞恢复时间较短,运动阻滞恢复较快,低血压、恶心、呕吐、尿潴留发生率较0.5%布比卡因等比重组低（P〈0.05）。结论罗哌卡因和布比卡因用于肛门直肠手术均能达到满意的临床效果,但等比重罗哌卡因腰麻运动阻滞恢复较快,低血压、恶心、尿潴留发生率较少,较0.5%布比卡因等比重液腰麻在肛肠手术中具有明显的优越性。

Objective To explore anesthetic effect of ropivacaine of isobaric spinal anesthesia （ISA） for anoreetal surgery. Methods Sixty ASA grade Ⅰ -Ⅱ patients, who had undergone anoreetal surgery,were randomly divided into 0.5% bupivacaine group and 0.5% ropivaeaine group. Vital signs of BP,HR,SpO2 were monitored in both groups. Sensation block , movement block, and onset and duration of block were recorded. Hypotension, urine retention, nausea and vomiting were recorded too. Results The onset of sensory block and motor block in the ropivacaine group were significantly longer than those in the bupivacaine group （ P 〈 0. 05 ） Modified Bromage motor scale score was higher than that of bupivaeaine group （ P 〈 0. 05 ）. The sensor recovery time and the motor recovery time was significantly shorter than those of bupivaeaine group（ [320.00 ±44. 023 min] , P 〈 0. 05 ）. The decrease of blood pressure and urine reserve were more frequent in ropivaeaine group than in bupivaeaine group （ P 〈 0.05 ）. Conclusion Both ropivacaine and bupivacaine can obtain satisfactory clinical outcome for patients undergoing anorectal surgery, but 0. 5% ropivacaine in isobaric spinal anesthesia can provide a better anesthetic effect,shorter motor recovery time and less adverse reactions.