定容小剂量利多卡因和罗哌卡因蛛网膜下腔麻醉在输尿管镜技术日间手术中的应用研究

Study of isovolumetric small-dose lidocaine and ropivacaine spinal anesthesia in ambulatory surgery of ureteroscopy

目的探讨定容小剂量利多卡因和罗哌卡因蛛网膜下腔麻醉（腰麻）应用于输尿管镜技术日间手术的有效性和安全性。方法前瞻性纳入输尿管镜技术日间手术患者100例，按随机数字表法分为4组（每组25例）：L1组，利多卡因10mg；L2组，利多卡因15mg；R1组，罗哌卡因10mg；R2组，罗哌卡因15mg。分别将所用麻醉药物稀释于脑脊液至3ml，给药速度0．2ml／s。记录麻醉前（T0）及麻醉给药后3min（T1）、6min（T2）、20min（T3）、30min（T4）、60min（T5）时患者SBP、DBP、HR等指标变化，监测感觉阻滞起效时间、运动阻滞起效时间、麻醉质量和毒副作用，评估痛觉恢复时间、运动阻滞恢复时间和留院时间。结果麻醉后L1组、R1组循环稳定，L2组、R2组在30min内BP和HR下降（P〈0．05）。各组感觉阻滞起效时间差异无统计学意义（P〉0．05），L1组、L2组运动阻滞较R1组、R2组起效时间缓慢且效果轻微。Lovett评分L1组显著高于其他3组（P〈0．05），L1组的留院时间显著低于其他3组（P〈0．05），各组均未发现短暂性神经综合征（transient neurological symptoms，TNS）等毒副作用。结论定容小剂量利多卡因腰麻方法循环稳定、感觉阻滞完善、运动阻滞弱、留院时间短、神经毒性极小，可以安全有效地应用于输尿管镜技术日间手术。

Objective To compare the anesthetic efficacy and safety of isovolumetric small-dose lidocaine and ropivacaine spinal anesthesia in ambulatory case of ureteroscopy. Methods One hundred ASA Ⅰ , Ⅱ patients scheduled for ambulatory ureteroscopy under spinal anesthesia were randomly divided into four groups （n=25）. Group L1 with lidocaine 10 mg, group L2 with lidoeaine 15 mg, group R1 with ropivacaine 10 mg, and group R2 with ropivacaine 15 mg. All local anesthetics were diluted to 3 ml with cerebrospinal fluid. BP, HR, the onset and recovery time of sensory and motor block anesthetic effects, neurological complications, and length of stay in hospital were recorded. Results After spinal anesthesia, BP and heart rate in groups L1 and R1 were stable, but decreased in groups L2 and R2. There were no significant differences regarding the onset of sensory block among all groups. The onset of motor block in lidocaine groups were slower and milder than that in ropivacaine groups. Lovett score in group L1 was significantly higher than the other three groups, length of stay in hospital and recovery time of analgesia in group L1, group L2 were significantly shorter than those of groups R1 and R2. There was no transient neurological syndrome （TNS）during follow-up. Conclusions Small-dose lidocaine spinal anesthesia can be safely applied to ambulatory ureteroscopysince itprovided stable circulation status, perfect the sensory block, weak motor block, short hospital stay, and no neurological toxicity.