不同剂量布比卡因腰麻用于肛肠手术的临床研究

Clinical study on spinal anesthesia with different dosages of bupivacaine in anorectal surgery

目的观察不同剂量布比卡因用于腰麻对肛肠手术麻醉效果及术后并发症的影响。方法选择拟接受肛肠科手术患者60例,ASA I-III级,随机平均分为三组,使用不同剂量布比卡因实施腰麻,A组:2.5 mg,B组:3.5 mg,C组:7.5 mg。观察三组患者麻醉前5 min,麻醉后5 min及手术结束后5 min平均动脉压(MAP)和心率(HR);因麻醉效果欠佳,术中补药的例数;术后1 h、2 h、4 h尿潴留发生率及下床活动例数。结果三组患者麻醉前5 min,麻醉后5 min及手术结束后5 min MAP和HR均无统计学差异;A组、B组术后尿潴留发生率低于C组(P<0.05),下床活动例数多于C组(P<0.05),但A组术中因镇痛不全需要补充舒芬太尼辅助镇痛的例数多于B、C组(P<0.01)。结论 3.5mg布比卡因腰麻能够安全有效地应用于肛肠手术,并能有效地减少麻醉后并发症。

Objective To observe the effect and postoperative complications of spinal anesthesia with different dosages of bupivacaine in anorectal surgery. Methods Sixty patients underwent anorectal surgery under spinal anesthesia were randomly divided into three groups. Patients in group A,B and C were given with bupivacaine 2. 5 mg,3. 5 mg and 7. 5 mg respectively for anesthesia. MAP and HR were examined at 5 min before anesthesia,5 min after anesthesia and 5 min after the operation. The number of cases with additional intraoperative administration of anesthesic drug due to ineffective anesthesia,the incidence of urinary retention and getting out of bed at 1,2,4 hours after the operation were recorded. Results There was no significant difference in MAP and HR among patients in these three groups at 5 min before anesthesia,5 min after anesthesia and 5 min after operation. The incidence of urinary retention in patients of group A and B was lower than that in patients of group C（ P〈0. 05） and the number of cases of geting- off bed was higher in group A and B than that in group C（ P〈0. 05） after the operation,but the number of cases with additional intraoperative administration of drug due to insufficiency of analgesia in patients of group A was higher than that of patients in group B and C respectively（ P〈0. 01）. Conclusion The dosage of 3. 5 mg bupivacaine for spinal anesthesia can safely and effectively be used for anorectal surgery and it can effectively reduce the postoperative complications of anesthesia.