小剂量布比卡因腰麻在肛瘘手术治疗中的临床分析

Clinical analysis of low-dose bupivacaine spinal anesthesia in surgical treatment of anal fistula

目的观察小剂量布比卡因腰麻在肛瘘手术治疗中的麻醉效果及不良反应。方法将173例肛瘘患者随机分为A、B、C 3组,其中A组58例,腰麻剂量为0.75%布比卡因1.5 ml;B组58例,腰麻剂量为0.75%布比卡因1.0ml;C组57例,腰麻剂量为0.75%布比卡因0.6 ml。观察3组患者的麻醉效果,麻醉前后肛管内压变化,麻醉后肛直肠环可及度、不良反应及并发症,并对其差异进行比较。结果 C组镇痛效果与A、B组比较差异无统计学意义(P>0.05),麻醉后肛管内压、肛直肠环可及度明显高于A、B组(P<0.05),尿潴留发生率明显低于A、B组(P<0.05)。结论 0.75%布比卡因0.6 ml腰麻,既有满意的镇痛效果,又能清楚扪及肛直肠环,在肛瘘手术时,既避免损伤肛门自制功能,又避免盲目挂线治疗,为治疗提供了解剖辨认基础,且术后尿潴留发生率低。

Objective To observe the anesthetic effects and adverse reactions of low-dose bupivacaine in surgical treatment of anal fistula. Methods The 173 patients given spinal anesthesia in anal fistula surgery were randomly divided into three groups. The group A （n=58） received 0.75% bupivacaine 1.5 ml, group B （n=58） received 0.75% bupivacaine 1.0 ml and group C （n=57）received 0.75% bupivacaine 0.6 mh To observe and compare the analgesia effects,the differences between anal canal pressure before and after spinal anesthesia ,the anal rectum ring after anesthesia and the adverse reactions after surgery. Results The anlagesic effect in the group C had no statistical difference compared with the group A and B （P〉0.05）. After spinal anesthesia, the anal canal pressure of group C were higher than that of the group A and B, the accessibility of anal rectum ring in the group C was obviously higher than that in the group A and B （P〈0.05）, and the incidence of uroschesis was apparently lower than that in the group A and B. Conclusion Using 0.75% bupivacaine 0.6ml in spinal anesthesia can acquire the satisfactory anlagesic ef- fect and the anal rectum ring can be clearly palpated, which not only avoids the damage of anal autonomic function, but also avoids thread-drawing therapy in anal fistula surgery, and provides the anatomical identifiable basis with the low incidence of postoperative uroschesis.