芬太尼对肛门直肠手术患者小剂量罗哌卡因腰麻效果的影响

Effect of fentanyl on efficacy of low-dose ropivacaine for spinal anesthesia in patients undergoing anorectal surgery

目的评价芬太尼对肛门直肠手术患者小剂量罗哌卡因腰麻效果的影响。方法择期行肛门直肠手术患者40例，性别不限，年龄20～55岁，BMI 18～28kg／m2，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将患者分为2组（n=20）：0．5％罗哌卡因7．5mg组（R组）和0．3％罗哌卡因6．0mg＋芬太尼10μg组（RF组）。L3,4间隙行蛛网膜下腔穿刺，穿刺针斜面朝向骶尾部，R组注射重比重0.5%罗哌卡因1．5ml，RF组注射重比重0．3％罗哌卡因6．0mg＋芬太尼10μg混合液2．0ml。记录感觉阻滞起效时间、最高感觉阻滞平面、感觉阻滞持续时间、运动阻滞起效时间和运动阻滞持续时间，记录术毕时改良Bramage评分。结果 与R组比较，RF组感觉阻滞持续时间和运动阻滞持续时间缩短，术毕时改良Bromage评分降低（P〈0．05或0．01）；感觉阻滞起效时间、最高感觉阻滞平面、运动阻滞起效时间及不良反应发生率差异无统计学意义（P〉0．05）。结论10μg芬太尼混合0．3％罗哌卡因6mg腰麻可满足肛门直肠手术要求，运动神经的阻滞轻，恢复快。

Objective To evaluate the effect of fentanyl on the efficacy of low-dose ropivacaine for spinal anesthesia in patients undergoing anoreetal surgery.Methods Forty ASA Ⅰ or Ⅱ patients, aged 20-55 yr, with body mass index 18-28 kg/m2 , scheduled for anureetal surgery., were randnmly divided into 2 groups （n=20 each）： 0.5% rupivacaine 7.5 mg group （group R） and 0.3% ropivacaine 6.0 mg ＋ fentanyl 10μg group （group RF）. A catheter was implanted into the subarachnnid space （L3,4 interspace） and advaneed caudally until lumbar region. Grnup R received hyperbaric 0.5% ropivacaine 1 .5 ml. Groap RF received 2.0 ml mixture of hyperbarie 0.3% ropivaeaine 6.0 mg and fentanyl 10μg. The onsel time of sensory and motor bock,upper level of sensory block, and duration of sensory and motor block were recorded. Motor block was assessed by modified Bromage scale. Results Compared with group R, the duration of sensory and motor block was significantly shortened, and modified Bromage scores were significantly decreased in group RF （ P 〈 0.05 or 0.01 ）,and no significant change was found in the onset time of sensory and molter block and upper level of sensnry block between the two groups （P 〉 0.05）. Conclusion 0.3% ropivaeaine 6.0 mg combined with fentanyl 10 μg provides satisfactory spinal anesthesia for anorectal surgery, with lower degree and faster recovery of motor block.