布比卡因复合舒芬太尼腰麻在输尿管镜下气压弹道碎石术中的应用

The clinical efficacy of sufentanil combined with 0.75%bupivacaine subarachnoid block in ureteroscopy and pneumatic lithotripsy

目的观察经尿道输尿管镜下气压弹道碎石术中0.75%布比卡因复合舒芬太尼腰麻的效果,并测定布比卡因ED50。方法择期行经尿道输尿管镜下气压弹道碎石术的患者54例,随机分为两组,B组(n=28)腰麻液为单纯0.75%布比卡因,BS组(n=26)腰麻液为0.75%布比卡因复合舒芬太尼10μg。采用序贯法确定0.75%布比卡因剂量,初始剂量均为1.6ml(12mg),剂量梯度为0.2ml(1.5mg),以麻醉平面是否达T10为剂量增减指标。采用Probit回归分析计算布比卡因ED50及其95%可信区间(CI)。结果 B组布比卡因ED50为1.90ml(14.25mg),95%CI1.54～2.60ml(11.55～19.5mg),BS组布比卡因ED50为1.70ml(12.75mg),95%CI1.34～2.18ml(10.05～16.35mg)。BS组反映瘙痒发生率明显高于B组(35%vs.0%,P<0.01)。结论经尿道输尿管镜下气压弹道碎石术腰麻时,舒芬太尼10μg能使0.75%布比卡因ED50减少10.5%。

Objective To observe the clinical efficacy of sufentanil combined with 0. 75% bupivacaine subarachnoid block in patients undergoing ureteroscopy and pneumatic lithotripsy. Methods Fifty-four patients undergoing ureteroscopy and pneumatic lithotripsy were randomized into two groups： group B （0. 75% bupivacaine, n=28） and group BS （0.75% bupivacaine plus sufentanil 10ug, n= 26）. Sequential method was designed to determine the dosage of bupivacaine in both groups. The initial dose of bupivacaine was 0. 750% bupivacaine 1.6 ml （12 rag）, and the gradient was 0. 2 ml （1.5 rag）. The effective dose was defined as a T10 level attained. EDs0 and 95% confidence interval（CI） of bupivacaine were calculated using Probit regression analysis. Results The El^0 of 0.75~ bupivacaine was 1.90 ml （95% CI： 1.54-2.60 ml） in group B, and 1.70 m1（95%CI： 1.34- 2.18 ml） in group BS, respectively. The incidence of pruritus was higher in group BS than that in group B（35% vs. 0%, P〈0.01）. Conclusion Sufentanil 10/2g produced a 10. 5% reduction of EDs0 of 0. 75% bupivacaine for subarachnoid block in patients undergoing ureteroscopy and pneumatic lithotripsy.