25G细针复合小剂量罗哌卡因腰麻在肛周疾病手术中的应用效果

Application of 25G fine needle combined low dose ropivacaine spinal anesthesia in perianal diseases operation

目的探讨25G细针复合小剂量罗哌卡因腰麻在肛周疾病手术中的应用效果。方法选择2013年1月至2017年12月间我院病房收治的肛周疾病患者240例为研究对象,随机分为25G细针复合罗哌卡因组(A组)、普通腰穿针布比卡因组(B组)、普通腰穿针罗哌卡因组(C组),25G细针布比卡因组(D组)共四组,每组各60例。观察各组麻醉起效时间、维持时间,一次穿刺成功率,下肢肌力恢复时间和自主排尿恢复时间,麻醉不良反应及并发症的发生率。结果 A、D组1次成功率较B、C组明显增加,差异有显著性(P<0.05)。A组麻醉起效时间较其他三组明显缩短,差异有显著性(P<0.05)。A、D组麻醉维持时间较B、C组明显缩短,A组缩短更明显,差异有显著性(P<0.05)。A组术后头痛及尿潴留严重程度较B、C、D三组明显下降(χ~2=10.57、8.29、2.5;χ~2=11.37、6.98、3.36,P<0.05); D组术后头痛及尿潴留发生严重程度较B、C两组明显下降(χ~2=3.33、2.0;χ~2=2.45、0.75,P<0.05)。术后观察各组下肢肌力恢复时间和自主排尿恢复时间,A、C两组较B、D两组比较明显缩短,差异有统计学意义(P<0.05); A组较C组下肢肌力恢复时间和自主排尿恢复时间明显缩短(P<0.05); D组较B组下肢肌力恢复时间和自主排尿恢复时间明显缩短(P<0.05)。结论 25G细针复合小剂量罗哌卡因在腰麻过程中,术中痛觉阻滞效果好,术后运动神经恢复快,不良反应发生率低,是肛周疾病手术理想的麻醉方法,值得临床推广使用。

Objective To explore the application effect of 25G thin needle combined with low dose ropivacaine for lumbar anesthesia in perianal diseases.Methods 240 patients with perianal disease were admitted to our hospital from January 2013 to December 2017,such as 25G fine needle compound ropivacaine group (group A),common lumbar puncture needle Bupivacaine group (group B),common lumbar puncture needle ropivacaine group (C group),25G fine needle bupivacaine group (group D),etc.There were 60 cases in each group.The onset time of the anesthesia,the time of maintenance,the success rate of one puncture,the recovery time of lower limb muscle strength and the recovery time of autonomous urination,the incidence of adverse drug reactions and complications were observed.Results the success rate of 1 times in group A and group D was significantly higher than that in group B and C ( P <0.05).The onset time of anesthesia in group A was significantly shorter than that in the other three groups ( P <0.05).The duration of anesthesia in group A and group D was significantly shorter than that in group B and C,and the shortening of A group was more obvious,with significant difference ( P <0.05).The severity of headache and urinary retention in group A was significantly lower than that in B,C,D three groups.The difference was significant (χ^2=10.57,8.29,2.5,χ^2=11.37,6.98,3.36,P <0.05),and the severity of headache and urinary retention in D group was significantly lower than that in B and C two groups (χ^2=3.33,2,χ^2= 2.45,0.75,0.05).After the operation,the recovery time of lower extremity muscle strength and the time of spontaneous urination were observed.There was a significant difference between the two groups of A and C compared with that of the B and D groups ( P <0.05).The difference was statistically significant ( P <0.05).In the A group, the recovery time of lower limb muscle strength and the recovery time of Autonomous Urination were significantly shorter in the A group than in the C group,and the difference was compared with those in the C group.The significance of study was ( P <0.05);in group D,the recovery time of lower limb muscle strength and the recovery time of autonomic urination were significantly shorter than those in group B,and the difference was statistically significant ( P <0.05).Conclusion In the process of lumbar anesthesia, 25G fine needle combined with small dose ropivacaine has good pain block effect, fast recovery of motor nerve after operation and low incidence of adverse reaction.It is an ideal anesthesia method for the operation of perianal disease.It is worthy of clinical application.