25G细针小剂量罗哌卡因腰麻在肛肠科手术中的应用效果及安全性研究

Application Effect and Safety of 25G Fine Needle Low-dose Ropivacaine Spinal Anesthesia in Anorectal Surgery

目的探究小剂量罗哌卡因细针腰麻在肛肠科手术的临床效果及安全性。方法从来该院诊治的2017年8月—2018年8月肛肠手术患者中随机抽取100例,采用随机数字法随机分为对照组50例:实施22G普通腰穿针重比重0.5%罗哌卡因10~12 mg腰麻,观察组50例:实施25G细针重比重0.5%罗哌卡因7.5~9 mg腰麻,观察两组患者临床麻醉效果、下肢肌力、自主排尿恢复时间、尿潴留和头痛情况、心动过速、满意度、低血压情况。结果两组患者麻醉总有效率均为100%,观察组麻醉效果优良率及满意度94%高于对照组(82%),差异有统计学意义(χ^2=11.753, P<0.05),观察组尿潴留发生率6%低于对照组,差异有统计学意义(P<0.05),头痛评分低于对照组,差异有统计学意义(P<0.05),头痛发生率2%低于对照组,差异有统计学意义(χ^2=11.082,P<0.05),心动过速发生率4%低于对照组,差异有统计学意义(χ^2=10.673,P<0.05),低血压发生率2%低于对照组,差异有统计学意义(χ^2=9.428,P<0.05);观察组下肢肌力恢复时间为(2.75±0.35)h低于对照组,差异有统计学意义(t=11.253,P<0.05),自主排尿恢复时间为(10.25±2.64)h低于对照组,差异有统计学意义(t=10.463,P<0.05)。结论 25G细针小剂量罗哌卡因腰麻在肛肠科手术中可有效降低患者术后不良反应,提高麻醉安全性和临床效果,是一项值得推广使用的麻醉方案。

Objective To investigate the clinical efficacy and safety of low-dose ropivacaine in the treatment of spinal anesthesia in anorectal surgery. Methods A total of 100 patients with anorectal surgery from August 2017 to August2018 in our hospital were randomly selected and randomly divided into the control group by 50 patients: 22 G ordinary lumbar puncture needle weight specific gravity 0.5% ropivacaine 10-12 mg spinal anesthesia, 50 cases in the observation group: 25 G fine needle weight 0.5% ropivacaine 7.5-9 mg spinal anesthesia, observe the clinical anesthesia effect,lower limb muscle strength, spontaneous urination recovery time, urinary retention and Headache, tachycardia, satisfaction, hypotension. Results The total effective rate of anesthesia was 100% in both groups. The excellent rate of anesthesia and satisfaction in the observation group was 94% higher than that in the control group(82%),the difference was statistically significant(χ~2=11.753, P<0.05). The incidence of urinary retention in the observation group was 6%. Lower than the control group, the difference was statistically significant(P<0.05), the headache score was lower than the control group(P<0.05), the headache incidence rate was 2% lower than the control group,the difference was statistically significant(χ~2=11.082, P<0.05), and the tachycardia incidence rate was 4% lower than the control group,the difference was statistically significant(χ~2=10.673,P<0.05). the incidence of hypotension was lower than 2% in the control group,the difference was statistically significant(χ~2=9.428, P<0.05). The recovery time of the lower extremity muscle strength in the observation group was(2.75±0.35)h lower than the control group,the difference was statistically significant(t=11.253, P<0.05), the recovery time of spontaneous urination was(10.25±2.64)h lower than the control group,the difference was statistically significant(t=10.463, P<0.05). Conclusion 25 G fine needle low-dose ropivacaine spinal anesthesia can effectively reduce postoperative adverse reactions and improve the safety and clinical effect of anesthesia in anorectal surgery. It is an anesthesia program worthy of popularization.