低给药速度下蛛网膜下腔阻滞对老年患者TURP手术麻醉效果的影响

The effect of subarachnoid block on the anesthesia effect of urological surgery in elderly patients with low drug delivery rate

目的评估低给药速度在腰椎椎体(L3~L4)间隙行重比重罗哌卡因单次蛛网膜下腔阻滞对老年患者经尿道前列腺电切术(transurethral resection of prostate,TURP)手术麻醉效果的影响。方法择期行TURP的老年患者102例,术前右侧卧位下超声定位下腰椎椎体L3~L4腰椎椎间隙,采用随机数字表随机分3组(n=34):L组给药速度0.025 mL/s,M组给药速度0.05 mL/s,H组给药速度0.1 mL/s。记录并比较3组的给药前(T_(0))、给药后1 min(T_(1))、5 min(T_(2))、10 min(T_(3))、15 min(T_(4))、30 min(T_(5))各时点的血流动力学变化、麻醉平面以及恶心呕吐、头晕头痛等不良反应的发生率。结果与M、H组相比,L组收缩压(systolic blood pressure,SBP)下降幅度较低,血流动力学波动较小(P<0.05);血管活性药使用率低(P<0.05);医生满意度评分、患者满意度评分高(P<0.05);恶心呕吐发生低(P<0.05)。结论以低给药速度(0.025 mL/s)对老年患者行单次蛛网膜下腔阻滞血流动力学更加稳定,且具有更高安全性,值得临床推广。

Objective To evaluate the effect of a single subarachnoid block of gravity ropivacaine in the gap between L 3 and L4 at a low rate of administration on the anesthesia effect of transurethral resection of prostate(TURP)in elderly patients.Methods 102 elderly patients who underwent elective TURP were treated with ultrasound in the right decubitus position before the operation to locate the L3~L4 lumbar intervertebral space were randomly divided into 3 groups using a random number table(n=34):L group(0.025 mL/s,),M group(0.05 mL/s,),and H group(0.1 mL/s,).The incidence of adverse reactions such as hemodynamic changes,level of anesthesia,nausea and vomiting,dizziness and headache at each time point of the 3 groups before administration(T_(0)),after administration 1 min(T_(1)),5 min(T_(2)),10 min(T_(3)),15 min(T_(4)),and 30 min(T_(5))were recorded and compared between the three groups.Results Compared with the M and H groups,the L group had a little decrease of systolic blood pressure(SBP)and a less hemodynamic fluctuations(P<0.05);the frequency of the vasoactive drugs was lower(P<0.05);doctors’satisfaction scores and patients’satisfaction scores were higher(P<0.05);the occurrence time of nausea and vomiting was lower(P<0.05).Conclusion A single subarachnoid block in elderly patients at a low dosing rate(0.025 mL/s)has more stable hemodynamics and higher safety,which is worthy of clinical promotion.