超小剂量重比重布比卡因蛛网膜下腔阻滞用于肛肠手术的临床观察

Clinical observation of super low-does hyperbaric bupivacaine for subarachnoid block anesthesia used in anorectal surgery

目的:观察超小剂量重比重布比卡因蛛网膜下腔阻滞用于肛肠手术的效果与可行性。方法:选择90例拟蛛网膜下腔阻滞下行肛肠手术患者,随机分为A、B、C三组,每组30例。A组蛛网膜下腔注入重比重布比卡因2.5 mg;B组蛛网膜下腔注入重比重布比卡因5 mg;C组蛛网膜下腔注入重比重布比卡因7.5 mg。观察并记录三组患者不同时点血流动力学变化;感觉阻滞起效时间、维持时间;双下肢运动阻滞程度(Bromage改良法)及术后尿潴留发生情况。结果:三组患者不同时点血流动力学变化及感觉阻滞起效时间比较,差异无统计学意义(P>0.05);A组感觉阻滞持续时间明显短于B、C组,A组<B组<C组,差异有统计学意义(P<0.05);A组双下肢运动神经阻滞程度与术后尿潴留发生情况明显低于B、C组,A组<B组<C组,差异有统计学意义(P<0.05)。结论:2.5 mg重比重布比卡因蛛网膜下腔阻滞用于肛肠手术麻醉效果满意,不良反应少,值得在临床工作中推广使用。

Objective To observe the effect and feasibility of super low-does hyperbaric bupivacaine for subarachnoid block anesthesia used in anorectal surgery. Method Ninety patients scheduled for anorectal surgery under subarachnoid block anesthesia were randonly divided into 3 groups with 30 cases each. Group A was given hyperbaric bupivacaine 2. 5 mg into the subarachnoid space; group B was given hyperbaric bupivacaine 5 mg; group C was given hyperbaric bupivacaine 7. 5 mg. The hemodynamics on different point were recorded; the onset and duration time of sensory block and the degree of motor block in double lower limbs and the incidence of uroschesis after operation were aslo recorded in there groups. Results There were no significant differences in the hemodynamics on different point and the onset time of sensory block among the three groups（ P 0. 05）. The duration time of sensory block in group A was considerably shorter compared with group B and group C,group A group B group C（ P 0. 05）. The degree of motor block in double lower limbs and the incidence of uroschesis after operation in group A were significantly lower compared with group B and group C,group A group B group C（ P 0. 05）. Conclusion The anesthesia effect of 2. 5 mg hyperbaric bupivacaine for subarachnoid block anesthesia used in anorectal surgery is satisfactory,and with less adverse reaction,it is worthy of spreading to clinical use.