不同浓度与剂量的布比卡因对蛛网膜下腔阻滞患者术后尿潴留的影响

Effects of different concentration and doses of bupivacaine on postoperative urinary retention in patients undergoing subarachnoid anesthesia

目的观察不同浓度和剂量布比卡因对蛛网膜下腔阻滞患者术后尿潴留的影响。方法下腹部或下肢手术患者120例，随机分为4组，分别采用0．250％（I组），0．375％（Ⅱ组），0．500％（Ⅲ组）等比重布比卡因3ml于2-3，间隙行蛛网膜下腔阻滞，并于硬膜外向头侧置管3cm。对照组（C组）采用0．5％罗哌长因单纯硬膜外麻醉。观察患者麻醉效果、生命体征变化，记录处理过程，于术24h后随访患者排尿功能的改变以及是否留置尿管。结果与Ⅰ组比较，Ⅱ组和Ⅲ组患者单次蛛网膜下腔阻滞效果更优（P〈0．05），Ⅱ组和Ⅲ组差异无统计学意义P〉0．05）；术后尿管留置率：Ⅰ组、Ⅱ组、c组三组比较差异无统计学意义（P〉0．05），且均低于Ⅲ组（P〈0．05）。结论0．375％布比卡因3ml用于蛛网膜下腔阻滞能较快达到手术麻醉要求，且有较低尿潴留的发乍率。

Objective To investigate the effects of different concentration and dose of bupiva- caine on postoperative urinary retention in the patients undergoing subarachnoid anesthesia. Methods A total of 120 patients undergoing lower limp or hypogastrium surgery were randomly assigned to four groups （n = 30 in each）. To induce a subarachnoid anesthesia, 3 ml of isobaric bupivacaine was injected in group Ⅰ,Ⅱ, and Ⅲ （0.250%, 0. 375%, and 0. 500%, respectively） via an intervertebral puncture between L2 and L3. All the patients received cephalic insertion of 3 cm of the epidural catheter. The con- trol group （group C） received epidural anesthesia with 0.5% ropivacaine only. Anesthetic effect, vital signs, and processing procedure were recorded. After 24 hours, urinary function was followed up for uri- nary catheterization. Results The anesthesia effects in group Ⅱ and Ⅲ were much getter than that in group I, but no significant difference was found between group II andⅢ. There was no significant difference in the incidence of postoperative urinary retention among group Ⅱ, Ⅱ and C, but the incidence of postoperative urinary retention and intraoporative hypotension in all these groups were lower than group Ⅲ. Conclusion Subarachnoid anesthesia with 3 ml of 0.375% isobaric bupivacaine not only meets the operation requirement, but also has a low incidence of urinary retention.