不同体位小剂量0．5％盐酸左布比卡因鞍区麻醉在肛门病手术中的应用比较

Application Study on by Different Position Saddle Block Anesthesia with Low-dose of 0.5 % Levobupivacaine Hydrochloride in the Operation for Anorectal Disease

为比较不同体位小剂量0．5％盐酸左布比卡因鞍区麻醉（简称鞍麻）在肛门病手术中的应用效果，将拟行手术治疗的200例肛门病患者随机分为A、B两组，各100例，两组麻醉用药均为0．5％盐酸左布比卡因注射液0．8ml（4mg）加麻黄素3～5mg。A组：传统“坐位”鞍麻，即患者取侧卧位或坐位行L3—4或L4—5穿刺并注药，然后保持坐位10～15min后改平卧位。B组：“头高足低位”鞍麻，即患者取侧卧位行L3—4或L。4—5穿刺成功后，改取头高足低位（10。～15。）注药，注药完毕后患者改平卧位。比较两组患者麻醉注药结束至术野消毒所需时间、围手术期血压和心率变化、下肢运动神经阻滞情况及术后并发症等。结果显示，两组患者均成功行鞍区神经阻滞，顺利完成手术，整个麻醉及手术过程中患者血压和心率均无明显变化（P〉0．05），均无下肢运动神经阻滞。但A组鞍麻注药完毕后患者需保持坐位10～15min才可开始手术，B组鞍麻注药完毕后即刻开始手术；而且A组鞍麻坐位等待时5例患者出现体位性低血压，改平卧位后缓解；术后48h内A组发生头痛14例，B组仅2例。结果表明，“头高足低位”小剂量0．5％盐酸左布比卡因鞍麻下行肛门病手术安全可靠，麻醉效果满意，而且可明显缩短鞍麻注药后至手术开始的等待时间，避免传统“坐位”鞍麻坐位等待时体位性低血压的发生，减少术后麻醉并发症，是一种较好的麻醉方法。

This study was to compare the efficaeies of by different position saddle block anesthesia with low-dose of 0.5 ~/0 levobupivacaine hydrochloride used in the operation for anorectal diseases. The 200 cases to be subjected to the operation for anorectal diseases were radomly divided into group A,B,100 cases for each;both groups all received 0.5~ levobupivacaine hydrochloride injection （0.8ml,i. e 4 mg） and ephed- rine（3-5 rag） ,but in group A,by conventional ＂seat position＂,i, e at lateral or seat position to stab and in- ject anesthesia agents in L3-4 or L4 5, for 10-15 min, then to change as flat decubitus position, while in group B,at the position of ＂head high and feet low＂,i, e at lateral position to stab in L3-4 or L4-5,after completely stab,at the ＂head high and feet low＂ posture（10^-15~） to inject agents,after end of injection,the position was changed as flat decubitus position;Then,the time from the end of injection to operation-field disinfection;the changes such as blood pressure,heart rate and lower limbs neuroblocked at perioperation, and postoperative complications,etc, were all recorded and compared with both groups. As resuhs,in both groups saddle block anesthesia was successful,and operation was smoothly completed; within anesthesia and operation blood pressure and heart rate did all have no significant changes（ P ）0.05）,also,no lower limb neuroblocked;But,in group A after the end of injection patients needed to at seat position for 10- 15rain the operation could when be at begining, while in group B after the end of injection the operation could be at once;in addition,during wait at seat position 5 cases of group A suffered from postural hypo- tension,and relieved just changed as flat decubitus position,and within 48 hrs after operation in 14 cases of group A occured headache, while in 2 cases of group B, only. Results show that the posture adapted by group B to perform 0.5 ~ levobupivacaine anesthesis used in the operation for anorectal diseases is safe and feasible,of satisfactory outcome,can significantly shorter the wait time from the end of injection to opera tion begining,so that to prevent from position hypotension occured during waiting after seat position saddle block anesthesia,to reduce postoeprative complication induced by anesthesia,thus it is of better anesthesis method.