二次下肢手术麻醉效果不佳处理措施的观察

Study on Different Treatment Measures to Second Lower Limb Surgery with Poor Onset Anesthesia Effect

目的观察碳酸利多卡因、甲磺酸罗哌卡因、左旋布比卡因用于二次下肢手术麻醉效果不佳的临床效果及安全性。方法选择ASAⅠ级或Ⅱ级二次下肢手术麻醉效果不佳患者90例,随机分为碳酸利多卡因组(T组)、甲磺酸罗哌卡因组(L组)、左旋布比卡因组(B组),每组30例。患者常规术前用药,行硬膜外穿刺置管,首量用碳酸利多卡因,用药后测试麻醉效果不佳者,分别用碳酸利多卡因、甲磺酸罗哌卡因、左旋布比卡因硬外腔注射,必要时重复,麻醉效果不满足手术的患者复合静脉麻醉。比较三组的麻醉起效时间、阻滞完全时间、麻醉效果优良率以及麻醉过程中生命体征的变化。结果三组年龄、性别、体重比较无统计学意义(P>0.05);B组生命体征波动较小,需复合静脉麻醉的例数较其他组少,效果优良,有统计学意义(P<0.05)。结论左旋布比卡因较适宜用于二次下肢手术麻醉效果不佳手术。

Objective To evaluate clinical effects and safety of carbonate lidocaine,ropivacaine mesilate or levobupivacaine for epidural anesthesia in patients undergoing second lower limb surgery with poor initial anesthesia effect.Methods 90 patients undergoing second lower limb surgery with poor initial anesthesia effect were randomly divided into carbonate lidocaine group（T）,ropivacaine mesilate group（L）,levobupivacaine group（B）.All the patients were made by continual epidural anesthesia with onset dosage of carbonate lidocaine and additional dosage of lidocaine,ropivacaine mesilate or levobupivacaine respectively in according group.Onset time,complete blockade time,successful rate and change of vital signs were recorded and compared.Results Group B showed Less change of vital signs and less patients needing adjuvant intravenous ansthetics（P0.05）.Conclusion Levobupivacaine was more beneficial as additional drug for epidural anesthesia in patients undergoing second lower limb surgery with poor initial anesthesia effect.