不同浓度罗哌卡因复合芬太尼腰硬联合麻醉用于经皮肾镜取石术的效果观察

Observation on Efficacy of Ropivacaine in Different Concentration Combined with Fentanyl in Combined Spinal-Epidural Anesthesia for Percutaneous Nephrolithotomy

目的:探讨不同浓度罗哌卡因复合芬太尼腰硬联合麻醉用于经皮肾镜取石术的效果。方法:回顾性选取2014年7月至2017年8月新余市中医院收治的拟行经皮肾镜碎石术患者102例,根据麻醉时罗哌卡因的给药浓度分为观察组56例、对照组46例。观察组患者采用0.15%罗哌卡因复合小剂量芬太尼进行腰硬联合麻醉,对照组患者采用0.3%罗哌卡因复合小剂量芬太尼进行腰硬联合麻醉,均行经皮肾镜取石术。观察两组患者的平均动脉压(MAP)、心率(HR)及血氧饱和度(SPO_2)水平,舒适度评分及改良Bromage评分。结果:与麻醉前比较,麻醉后5、10、20及30 min两组患者MAP水平轻度下降,SPO_2水平略有升高,但差异均无统计学意义(P>0.05);麻醉后20、30 min,两组患者HR较麻醉前明显降低,但观察组患者的HR明显高于对照组,差异均有统计学意义(P<0.05)。观察组患者平均舒适评分为(2.84±0.04)分,明显高于对照组的(2.10±0.05)分;观察组患者平均改良Bromage评分为(0.17±0.05)分,明显低于对照组的(0.34±0.06)分,上述差异均有统计学意义(P<0.05)。结论:0.15%罗哌卡因复合芬太尼腰硬联合麻醉用于经皮肾镜取石术的麻醉效果好,对血流动力学影响较小。

OBJECTIVE： To probe into the clinical efficacy of ropivacaine in different concentration combined with fentanyl in combined spinal-epidural anesthesia for percutaneous nephrolithotomy. METHODS： 102 patients undergoing percutaneous nephrolithotomy admitted into Xinyu Hospital of Traditional Chinese Medicine from Jul. 2014 to Aug. 2017 were retrospectively selected and divided into observation group（ 56 cases） and control group（ 46 cases） according to the different concentration of ropivacaine. The observation group was given 0. 15% of ropivacaine combined with low dose of fentanyl for combined spinal-epidural anesthesia,while the control group was given 0. 3% of ropivacaine combined with low dose of fentanyl for combined spinal-epidural anesthesia,both groups were given percutaneous nephrolithotomy.The mean arterial pressure（ MAP）,heart rates（ HR）,oxygen saturation（ SPO2）,comfort scores and improved Bromage scores of two groups were observed. RESULTS： Compared with before anesthesia,the MAP levels of both groups had been slightly decreased at 5 min,10 min,20 min and 30 min after anesthesia,with also slight increase of SPO2 levels,while the differences had no statistical significance（ P〈0. 05）. At 20 min and 30 min after anesthesia,the HR of both groups had been significantly decreased,and that of the observation group was significantly higher than the control group,with statistically significant differences（ P〈0. 05）. The average comfort score of observation group was（ 2. 84 ±0. 04） points,which was significantly higher than that of the control group [（ 2. 10 ± 0. 05） points ]; the average improved Bromage score of observation group was（ 0. 17 ± 0. 05） points,which was significantly lower than that of the control group [（ 0. 34 ± 0. 06） points],both with statistically significant differences（ P〈0. 05）. CONCLUSIONS： The efficacy of 0. 15% of ropivacaine combined with fentanyl in combined spinal-epidural anesthesia for percutaneous nephrolithotomy is remarkable,with few influence on hemodynamics.