超小剂量布比卡因复合芬太尼蛛网膜下腔麻醉在肛肠手术中的应用

Application of ultra-low dose bupivacaine combined with fentanyl in subarachnoid anesthesia during anorectal surgery

目的 观察超小剂量布比卡因复合芬太尼蛛网膜下腔注射麻醉在肛肠手术中的可行性,为临床选择合适麻醉方式及剂量提供合理依据。方法 选择2018年1月至2020年1月需要进行肛肠手术患者60例,随机分成3组,Ⅰ组:0.5%布比卡因7.5 mg+芬太尼5μg,Ⅱ组:0.5%布比卡因7.5 mg+芬太尼2.5μg,Ⅲ:0.5%布比卡因10 mg,进行蛛网膜下腔麻醉。观察麻醉阻滞起效时间、平面上界、维持时间、运动阻滞起效时间、阻滞程度、血流动力学影响及不良反应发生情况。结果 Ⅰ、Ⅱ组与基础值比较,收溶压(SBP)、舒张压(DBP)、心率(HR)生命体征指标均无差异(P>0.05);Ⅲ组与Ⅰ、Ⅱ组、基础值比较,麻醉给药后的10、15、30 min,SBP、DBP、HR指标均有显著差异(P<0.05);3组SpO2≥99%差异无统计学意义(P>0.05)。Ⅰ组感觉阻滞起效时间明显短于Ⅱ、Ⅲ组(P<0.05),维持时间长于Ⅱ、Ⅲ组(P<0.05);3组运动阻滞起效时间无明显差异(P>0.05);Ⅲ组运动阻滞恢复时间长于Ⅰ、Ⅱ组(P<0.05)。Ⅰ、Ⅱ组不良反应发生情况差异无统计学意义(P>0.05),Ⅲ组不良反应发生率明显高于Ⅰ、Ⅱ组(P<0.05)。结论 芬太尼2.5μg、5μg复合小剂量布比卡因蛛网膜下腔注射用于肛肠手术中均可产生良好的感觉和运动阻滞,且对血流动力学影响小。

Objective To investigate the feasibility of subarachnoid injection of ultra-low-dose bupivacaine combined with fentanyl in anorectal surgery,so as to provide a reasonable basis for clinical selection of appropriate anesthesia methods and doses.Methods Sixty patients who had to receive anorectal surgery were randomly divided into three groups:groupⅠ:0.5%bupivacaine 7.5mg+fentanyl 5μg;groupⅡ:0.5%bupivacaine 7.5mg+fentanyl 2.5μg;groupⅢ:0.5%bupivacaine 10mg.The onset time,upper plane boundary,maintenance time,motor block onset time,degree of block,hemodynamic effects and the incidence of adverse reactions were observed and compared among the three groups.Results There were no significant differences in the levels of SBP,DBP and HR between group I,group II and basis levels(P>0.05).There were significant differences in the levels of SBP,DBP and HR at 10min,15min,30min after anesthesia administration between groupⅢand groupⅠ,groupⅡ(P<0.05).There was no significant difference in the SpO2≥99%among the three groups(P>0.05).The onset time of sensory block in groupⅠwas significantly shorter than that in groupⅡand groupⅢ(P<0.05),and the duration was significantly longer than that in groupⅡand groupⅢ(P<0.05).There was no significant difference in the onset time of motor block among the three groups(P>0.05).The recovery time of motor block in groupⅢwas significantly longer than that in groupⅠand groupⅡ(P<0.05).Moreover the incidence of adverse reactions in groupⅢwas significantly higher than that in groupⅠandⅡ(P<0.05).Conclusion The subarachnoid injection of fentanyl(2.5μg,5μg)combined with low-dose bupivacaine in anorectal surgery can produce good sensory and motor block,which has little effect on hemodynamics.