低阻滞平面腰麻对日间病房肛周手术的临床效果

Clinical effects of spinal anesthesia with low blocking level for perianal surgery in day-care unit

目的分析低阻滞平面腰麻下行肛周手术的临床效果,探讨腰麻下小剂量缓慢给药的最佳剂量及注射速度。方法选择2016年8月至2017年3月在我院行肛周手术患者65例,按麻醉药剂量及注射速度不同分为2组:观察组布比卡因0. 6 m L,注药速度为0. 1 m L/5 s;对照组布比卡因1. 5 m L,注药速度为0. 1 m L/s。观察患者麻醉前,麻醉后10 min、30 min血压、心率,麻醉阻滞平面,抬臀能力,VAS,外科医生满意评分,患者满意评分,术后运动及疼痛恢复时间,腰麻后并发症情况。结果观察组阻滞平面、术后运动恢复时间和疼痛恢复时间明显低于对照组,差异有统计学意义(P <0. 05),且抬臀能力优于对照组,差异有统计学意义(P <0. 05)。本研究外科医生满意度、患者舒适度、VAS及腰麻后并发症差异无统计学意义。结论腰麻时采用小剂量、缓慢注药可获得较常规腰麻更低的阻滞平面,与常规腰麻下行肛周手术相比有更优的临床效果。

Objective To assess the clinical effects of spinal anesthesia with low blocking level for perianal surgery, and to explore the optimal dose and injection speed of low dose and slow administration under spinal anesthesia. Methods A total of 65 patients who planned to undergo perianal surgery in our hospital from August 2016 to March 2017 were selected.The patients were divided into the observation group and the control group randomly. For the observation group, the bupivacaine is 0.6 mL with slowly injection rate of 0.1 mL/5s.For the control group,the bupivacaine is 1.5 mL with injection rate of 0.1 mL/s.Observed the blood pressure and heart rates before anesthesia,10 minutes and 30 minutes after anesthesia. Recorded the blocking level, movement capability of hip, visual analogue scale (VAS), surgeon and patient satisfaction, time of pain relief, time of postoperative motion recovery, and complication of the the two groups after spinal anesthesia. Results In the observation group,the blocking level, time of pain relief, time of postoperative motion recovery were obviously lower than those of the control group ( P <0.05);and the movement capability of hip was obviously better than the control group ( P <0.05). There was no siginificant difference in satisfaction of surgeon and patient,VAS,and complication after spinal anesthesia between the two groups. Conclusion Low dose and slow drug injection speed in lumbar anesthesia can obtain a lower blocking level than conventional lumbar anesthesia, and it may have a better clinical effect in perianal surgery.