考察在30例肛肠日间手术中罗哌卡因蛛网膜下腔阻滞最低有效浓度

Minimum Effective Concentration of Ropivacaine for Subarachnoid Block in 30 Cases of Anorectal Day Surgery

目的观察罗哌卡因蛛网膜下腔阻滞用于肛肠日间手术的最低有效浓度,探讨其在肛肠日间手术中的合理用药浓度和安全性。方法30例在日间行肛肠手术的患者,根据序贯方法,以上例患者的麻醉效果,确定下例患者所用的罗哌卡因浓度,初始罗哌卡因浓度为0.50%,间隔浓度为0.05%,麻醉诱导后观察阻滞起效时间、阻滞完善时间、改良Bromage评分、VAS评分;术后随访观察麻醉镇痛时间、术后运动功能恢复时间、术后排尿功能恢复时间、不良反应及患者满意度。结果罗哌卡因用于肛肠日间手术的最低有效浓度为0.35%,剂量为7 mg,EC50为0.366%(95%CI:0.255%~0.423%),阻滞起效时间、阻滞完善时间、改良Bromage评分、VAS评分、麻醉镇痛时间、术后运动功能恢复时间与麻醉浓度差异有统计学意义(P<0.05)。药物浓度越高,阻滞起效时间、阻滞完善时间越短;药物浓度越低,麻醉镇痛时间越短,术后运动功能恢复越快,麻醉浓度与术后排尿功能恢复时间差异无统计学意义(P>0.05)。结论罗哌卡因用于肛肠日间手术的最低有效浓度为0.35%,剂量为7 mg,合适浓度罗哌卡因不仅能满足肛肠日间手术需求,也利于术后早期康复,为患者早日下床功能锻炼提供可能,安全有效。

Objective To observe the minimum effective concentration of ropivacaine for subarachnoid block in anorec-tal day surgery,and study its rational administration and safety in anorectal day surgery.Methods We applied sequen-tial procedure on thirty patients undergoing anorectal day surgery,the anesthetic effect of the last patient determines the concentration of ropivacaine used in the next patient.The initial concentration of ropivacaine was 0.50%and the interval concentration between two patients was 0.05%.After the induction,the onset time,finishing time,modified Bromage score and VAS score were observed;Postoperative follow-up was conducted to observe the analgesia time,postopera-tive recovery time of motor function,postoperative recovery time of urinary function,adverse reactions and patient sat-isfaction.Results The minimum effective concentration of ropivacaine for anorectal day surgery was 0.35%,with a dose of 7 mg and the EC50 value was 0.366%(95%CI:0.255%~0.423%).The onset time,finishing time,modified Bromage score,VAS score,anesthesia analgesia time,postoperative motor function recovery time and anesthetic con-centration were statistically significant(P<0.05).With a higher drug concentration,the onset time and finishing time operative motor function was faster.There was no statistical difference between the anesthetic concentration and postop-erative recovery time of urinary function(P>0.05).Conclusions The minimum effective concentration of ropivacaine for anorectal day surgery is 0.35%,and the dose is 7 mg.The appropriate concentration of ropivacaine can not only meet the needs of anorectal day surgery,but also promote early postoperative rehabilitation,providing the possibility of early ambulation and functional training.It is safe,efficient and worth promoting.