小剂量罗哌卡因复合芬太尼腰麻在宫腔镜手术中的应用

Application of Low-dose Ropivacaine combined with Fentanyl forspinal anesthesia in hysteroscope operation

目的:探讨小剂量罗哌卡因复合芬太尼腰麻用于宫腔镜手术的可行性。方法:180例拟在腰麻下行宫腔镜手术患者随机分为三组,每组60例。R10组给予罗哌卡因10mg,R5组给予罗哌卡因5mg,RF组给予罗哌卡因5mg+芬太尼15μg,三组均选L2～3间隙穿刺,用脑脊液稀释至2ml,针尖朝头,注药时间8s。监测记录患者循环功能、感觉阻滞程度、运动阻滞程度及不良反应。结果:RF组与R10组相比,感觉阻滞平面、麻醉效果优良率无显著性差异,用药后R10组血压下降、心率减慢(P<0.01),但RF组变化不明显,RF组用药后60minBromage评分高于R10组(P<0.01),运动阻滞程度明显轻于R10组;RF组与R5组相比,两组用药后血压、心率变化均不明显,用药后60minBromage评分无显著性差异,但RF组感觉阻滞平面、麻醉效果优良率高于R5组(P<0.01)。结论:小剂量罗哌卡因(5mg)复合芬太尼(15μg)腰麻用于宫腔镜手术感觉阻滞完善、麻醉效果满意,对血流动力学影响小,运动阻滞轻,不良反应少。

Objective：To explore the feasibility of low-dose Ropivacaine combined with Fentanyl for spinal anesthesia in hysteroscopic surgery.Methods：180 cases was intended to be down in hysteroscopic surgery of spinal anesthesia were randomly divided into three groups,each group of 60 cases,R10 group received ropivacaine 10mg,R5 group received ropivacaine 5mg,RF group received ropivacaine 5mg ＋ fentanyl 15μg,the pricking were manipulated through interspace lumbar nerves 2～3,three groups were diluted to 2ml with cerebrospinal fluid,the needle port toward the head,injection time of 8 seconds.Monitoring records in patients with circulatory function,sensory block level,motor block level and adverse reactions.Results：Sensory block plane and anesthesia of group RF was no significant difference between excellent and good rate compared with R10 group,the blood pressure was decreased and heart rate was slowed（P0.01）of group R10 after treatment,but that of RF group change was not obvious,the Bromage score of RF group were higher than R10 group（P0.01）,degree of motor block was significantly lighter than R10 group,blood pressure and heart rate of both groups changed not obvious after treatment 60 minutes.And compaired with R5 group,blood pressure and heart rates of both groups changed not obviously after treatment,Bromage score difference was not statistically significant.But the felt block plane and good anesthesia of group RF was higher than R5 group（P0.01）.Conclusion：Low-dose of ropivacaine（5mg）combined with fentanyl（15μg）spinal anesthesia for hysteroscopy sense block improved anesthesia satisfied with little effect on hemodynamics,exercise block light,and few adverse reaction.