氯普鲁卡因联合不同剂量芬太尼用于肛肠手术的临床观察

CLINICAL OBSERVATION OF EPIDURAL CHLOROPROCAINE COMBINED WITH DIFFERENT DOSES OF FENTANYL IN PATIENTS UNDERGOING ANORECTAL SURGERY

目的探讨氯普鲁卡因复合不同剂量芬太尼在肛肠手术中硬膜外麻醉的效果。方法选择肛肠手术硬膜外麻醉患者120例,随机分为3组各40例,A组3%氯普鲁卡因+芬太尼1mg/L,B组3%氯普鲁卡因+芬太尼2mg/L,C组3%氯普鲁卡因+芬太尼3mg/L。观察麻醉起效时间、痛觉消失时间、痛觉阻滞持续时间、运动阻滞时间、运动阻滞持续时间、肌肉松弛程度、术后5Inin视觉模拟评分(visual analogue scale,VAS)、手术时间、出院时间以及不良反应的发生率等。结果 B组和C组的麻醉起效时间和痛觉消失时间较A组缩短,C组较B组痛觉消失时间更短(P<O.05)。B组和c组痛觉阻滞持续时间长于A组(P<O.05);c组运动阻滞持续时间长于A组(P<0.05);B组和c组的术后5min VAS低于A组(P<0.05);B组手术时间短于A组和C组(P<0.05);C组的出院时间晚于A、B两组(P<0.05);C组的不良反应多于A组(P<0.05);肌肉松弛程度的比较差异无统计学意义。结论3%氯普鲁卡因分别复合1、2和3mg/L芬太尼硬膜外麻醉均可安全有效地用于肛肠手术,B组和C组的镇痛时间长于A组,而复合2mg/L芬太尼组的不良反应较少,是最佳复合剂量。

Objective To discuss the clinical efficiency of epidural anesthesia chloroprocaine combined with different doses of fentanyl in patients undergoing anorectal surgery. Methods One hundred and twenty patients undergoing anorectal surgery were randomly divided into three groups,forty patients in each group,group A,B and C respectively received epidural anesthesia with chloroprocaine combined with fentanyl 1,2,3mg/L. The onset time of anesthesia,the disappeared time of pain sensation, the duration of pain sensation block,the duration of motor block,the degree of muscle relaxation,the visual analogue scale（ VAS）scores at 5 min after surgery,the operation time,the discharge time and the incidence rate of adverse reactions were observed and recorded in three groups. Results Compared with group A,the onset time of anesthesia and the disappeared time of pain sensation in group B and group C＆amp;nbsp;were shorter;compared with group B,the disappeared time of pain sensation of group C was shorter. The duration of sensory block in group B and group C was longer than that of group A（ P﹤0 . 05 ）. The VAS score at 5 min after surgery was lower in group B and group C,group C compared with group B was lower （ P﹤0 . 05 ）. The duration of motor block of group C was longer than that of group A（ P﹤0 . 05 ）. The operation time in group B was shorter than that in group A and group C（ P ﹤0 . 05 ）. Compared with group A and group B,the discharge time in group C was later（P ﹤0. 05）. The incidence of adverse reactions in group C was more than that of group A（ P﹤0 . 05 ）. There were no statistical differences in the degree of muscle relaxation among three groups. Conclusion Epidural chloroprocaine combined with different doses of fentanyl（1mg/L,2mg/L,3mg/L）all can be used in daytime anorectal surgery safely and effectively,but the latter two groups provide the longer analgesic time than the first group and 2mg/L fentanyl is the optimum composite dose with less adverse reactions.