小剂量布比卡因混合舒芬太尼腰椎麻醉在老年病人经尿道前列腺电切术中的应用

MINIDOSE BUPIVACAINE PLUS SUFENTANYL FOR SPINAL ANESTHESIA IN TRANSURETHRAL RESECTION OF PROSTATE

目的探讨小剂量布比卡因、舒芬太尼用于老年经尿道前列腺电切术（TURP）病人腰椎麻醉的效果。方法将50例TURP病人随机分为A、B、C3组，A组以3g／L布比卡因1mL＋0．01g／L舒芬太尼1mL＋100g／L葡萄糖溶液1mL进行腰椎麻醉；B组以5g／L布比卡因1mL＋0．01g／L舒芬太尼1mL＋100g／L葡萄糖溶液1mL进行腰椎麻醉；C组以3．75g／L布比卡因2mL＋100g／L葡萄糖溶液1mL进行腰椎麻醉。记录注药前即刻（T0）及注药后5min（T1）、15min（T2）、30min（T3）时平均动脉压（MAP）、心率（HR）；记录感觉阻滞范围（以节段数表示）、镇痛持续时间、运动神经阻滞完全恢复时间、麻黄素使用例数。结果B、C组T1、T2、T3MAP值与T0比较均明显降低（t=8．246～21．574，P〈0．01）。与B、C两组相比，A组30min后麻醉阻滞范围明显减小（F=5．24，q=3．006、4．509，P〈0．05）。A、B组镇痛时间明显长于C组（F=27．49，q=7．598、10．031，P〈0．01）。A、B两组麻黄素使用例数明显少于C组（P=0．0045、0．0001），A组运动神经恢复时间明显少于B、C两组（F=70．60，q=12．999、15．824，P〈0．01）。结论3mg布比卡因混合舒芬太尼10μg用于椎管内麻醉对TURP老年人血流动力学功能影响小，运动恢复快。

Objective To explore the effectiveness of combined low dose bupivacaine with sufentanyl for spinal anesthesia in elderly patients undergoing transurethral resection of the prostate （TURP）. Methods Fifty patients were randomly divided into three groups： group A （n=16） received 1 mL of 3 g/L bupivacaine and 1 mL of 0.01 g/L sufentany mixed in 1 mL of 100 g/ L glucose solution; group g （n=17）, 1 mL of 5 g/L bupivacaine and 1 mL of 0.01 g/L sufentany in 1 mL of 100 g/L glucose solution; group C （n=17）, 2 mL of 3.75 g/L bupivacaine in 1 mL of 100 g/L glucose solution. Mean arterial pressure （MAP） and heart rate （HR） were recorded before drug infusion （T0）, 5 minutes （T1）, 15 minutes （T2） and 30 minutes （T3） after drug infu sion. The range of sense-blocking （recorded as section number）, analgesic duration, and recovery time of motor nerve function were examined. The number of patients using ephedrine during anesthesia was recorded. Results The MAPs of T1, T2 and T3 in groups B and C were significantly decreased compared with that of T0（t=8. 246 21. 574,P〈0.01）. The sense-blocking range of group A 30 min after drug infusion was significantly smaller than that of groups B and C （F= 5.24;q= 3. 006,4. 509;P〈0.05） The analgesic duration in groups A and B was significantly longer than that in group C （F= 27.49 ;q= 7. 598,10. 031 ; P〈0.01）. The number of patients using ephedrine in groups A and group B was smaller than that in group C （P=0. 004 5,0. 000 1）. The recovery time of motor nerve function in group A was shorter than in groups B and C （F= 70.60 ; q= 12. 999,15. 824 ; P〈0.01）. Conclusion Combined 3 mg bupivacaine with 10 μg sufentanyl in spinal anesthesia shows little effect on hemodynamics and with quick recovery of movement function in the aged patients undergoing TURP.