低平面等比重腰麻与鞍麻在肛肠手术中的效果比较

Isobaric lumbar anesthesia at low blocking planar versus saddle anesthesia in anorectal surgery

目的比较等比重低平面腰麻与鞍麻在肛肠手术中的效果。方法将80例行肛肠手术的患者随机分为鞍麻组(n=40)与低平面腰麻组(n=40)。鞍麻组采用常规鞍麻坐位下5.0 mg布比卡因联合10%葡萄糖0.3 mL向尾部缓慢注药麻醉,低平面腰麻组采用左侧卧位下5.0 mg的0.5%等比重布比卡因向尾部缓慢注药,控制麻醉平面于L 4~5水平。比较2组患者的麻醉操作时间、麻醉起效时间、镇痛持续时间、自主排尿恢复时间、下肢运动阻滞情况以及尿潴留情况。结果2组患者均顺利完成手术。低平面腰麻组麻醉操作时间、镇痛持续时间、自主排尿恢复时间显著短于鞍麻组(P<0.05),尿潴留发生率显著低于鞍麻组(P<0.05)。结论侧卧位下低平面等比重腰麻临床操作简便,麻醉效果确切,对患者下肢运动及循环功能影响小,较鞍麻可降低术后尿潴留的发生率。

Objective To compare effect of isobaric lumbar anesthesia at low blocking planar and saddle anesthesia in anorectal surgery.Methods Totally 80 patients with anorectal surgery were randomly divided into saddle anesthesia group(n=40)and lumbar anesthesia at low blocking planar group(n=40).In the saddle anesthesia group,5.0 mg bupivacaine combined with 0.3 mL 10%glucose was injected into the tail slowly under the normal sitting position,while 5.0 mg 0.5%isobaric bupivacaine was injected into the tail slowly under the left lying position in the low plane lumbar anesthesia group,and anesthesia plane was controlled at the level of L 4~5.The operation time of anesthesia,onset time of anesthesia,duration of analgesia,autonomic micturition recovery time,lower limb movement blocking and urine retention were compared between the two groups.Results The patients in both groups completed operation successfully.In the lumbar anesthesia at low blocking planar group,the operation time of anesthesia,duration of analgesia and autonomic micturition recovery time were significantly shorter than those in saddle anesthesia group(P<0.05),and the incidence rate of urinary retention was significantly lower than that in saddle anesthesia group(P<0.05).Conclusion Compared with saddle anesthesia,isobaric lumbar anesthesia at low blocking planar is easy to operate in clinical practice,which has advantages of better anesthetic effect,less influence on lower limb movement function and circulation,and lower incidence rate of postoperative urinary retention.