小剂量2%利多卡因骶管麻醉联合两点扇形麻醉在肛肠手术中的应用研究

Clinical application of low dose 2 % lidocaine sacral anesthesia combined with two-point fan anesthesia in anal surgery

目的探讨小剂量2%利多卡因骶管麻醉联合两点扇形麻醉法在肛肠手术中的临床应用效果。方法66例因痔、肛瘘、肛裂、肛周脓肿等肛肠疾病住院治疗的患者随机法分为对照组和观察组,每组33例。其中对照组患者术中均行腰麻、鞍麻、单纯骶麻等非联合麻醉方法麻醉,观察组患者术中均采用小剂量2%利多卡因骶管麻醉联合两点扇形麻醉法麻醉,监测并记录2组阻滞前10 min、阻滞后10、20、30 min各时段无创血压(MAP)、心率(HR)、血氧饱和度(SpO2)等血流动力学指标变化情况,分别记录2组患者感觉及运动阻滞维持时间,依据患者临床表现及主诉对2组患者的临床麻醉效果进行综合评定,采用VAS评分法对2组患者术后疼痛程度进行评价,比较2组术后48 h不良反应发生情况。结果观察组麻醉效果明显优于对照组(P<0.05);观察组阻滞前后SpO2、HR、MAP稳定性更佳,但2组差异无统计学意义(P>0.05);观察组感觉阻滞维持时间和运动阻滞维持时间较对照组明显缩短(P<0.05);术毕肛门收缩恢复率明显高于对照组,直肠牵拉反射率明显低于对照组(P<0.05);观察组患者术后VAS疼痛评分低于对照组,术后轻度疼痛患者比例明显高于对照组,术后不良反应发生率明显低于对照组(P<0.05)。结论相对传统的腰麻、鞍麻、单纯骶麻等麻醉方式,临床采用小剂量2%利多卡因骶管麻醉联合两点扇形麻醉法能为临床肛肠手术提供良好的便利条件,其不仅起效平稳,术后患者恢复快,而且能有效降低患者术后疼痛程度及临床不良反应情况的发生,值得临床推广应用。

Objective To investigate the clinical application effects of low dose 2 % lidocaine sacral anesthesia combined with two-point fan anesthesia in anal surgery.Methods A total of 66 patients with anal intestinal diseases including hemorrhoid,anal fistula,anal fissure and perianal abscess who were admitted and treated in our hospital from January 2015 to December 2015 were enrolled in the study,who were randomly divided into observation group(n=33) and control group(n=33).The patients in control group were treated by non-combined anesthesia methods including lumbar anesthesia,saddle anesthesia,and simple sacral anesthesia,however,the patients in observation group were treated by 2% lidocaine sacral anesthesia combined with two-point fan anesthesia,moreover, the changes of hemodynamics indexes including MAP,HR,and SpO2,at 10 min before anesthesia blocking,and at 10 min,20 min,and 30 min after anesthesia blocking were observed and recorded.The clinical anesthesia effects were evaluated according to their clinical performance and main complaint of patients.In addition the postoperative pain degree was evaluated by VAS scoring method,and the incidence rates of postoperative 48-hour adverse reactions were observed and compared between the two groups.Results The anaesthesia effects in observation group were superior to those in control group(P<0.05).There were no significant differences in SpO2,HR,MAP before and after anesthesia blocking between the two groups(P>0.05).The sensory block maintenance time and motion block maintenance time were in observation group were(177.81±14.01)min and(96.02±14.14)min,respectively,which were significantly shorter than those [(243.08±15.22)min and(129.64±14.50)min] in control group(P<0.05).Moreover the recovery rate of anal contraction was 100.00% in observation group,which was significantly higher than that(3.03%) in control group(P<0.05).In addition the VAS pain scores after operation in observation group were significantly lower than those in control group(P<0.05).And the proportion of patients with mild postoperative pain was 69.70%,which was significantly higher than that in control group,but the incidence rate of postoperative adverse reactions in observation group was significantly lower than that in control group(P<0.05).Conclusion In comparison to traditional anaesthesia methods including lumbar anesthesia,saddle anesthesia and simple sacral anesthesia, the clinical application of small dose of 2% lidocaine sacralanesthesia combined with two-point fan anesthesia can provide good convenience for clinical analintestinal surgery,which has the advantages of stable effects,faster postoperative recover,which can effectively reduce the postoperative pain degree of patients and the incidence of clinical adverse reactions,therefore, it is worthy of clinical application.