0.5%罗哌卡因腰硬联合麻醉在肛肠手术临床应用.doc

0.5%罗哌卡因腰硬联合麻醉在肛肠手术临床应用 　关键词：罗哌卡因；布比卡因；腰麻-硬膜外联合麻醉 摘要：目的 观察0.5%罗哌卡因腰硬联合麻醉在肛肠手术的应用及术后恢复情况。方法 随机选取择期行肛肠手术的患者48例,分为二组,罗哌卡因（RP）组和布比卡因（组），腰硬联合麻醉下,蛛网膜下腔给药。RP组蛛网膜下腔注入0.5%罗哌卡因2ml，BP组注入0.5%布比卡因2ml。结果 RP组的感觉阻滞与运动阻滞的起效时间均慢于BP组，最高感觉阻滞平面与最大运动阻滞程度均低于BP组，感觉阻滞持续时间与BP组无差异，运动阻滞持续时间则短于BP组。二组患者均未于硬膜外腔追加药物，均安全满意完成手术。结论 0.5%罗哌卡因腰硬联合麻醉是肛肠科手术安全可靠的麻醉选择。 Abstract:Aim To investigate the clinical use of 0.5% ropivacaine of combined epidural anaesthesia in the anus intestine disease operation.Methods 48 patients who had anus intestine disease were randomly assigned to 2 groups(24 patients in every group):ropivacaine(RP) group and bupivacaine(BP) group,using combined epidural anaesthesia,ropivacaine and bupivacaine were injected into subarachnoind.Using 0.5% ropivacaine 2ml spinal anaesthesia in RP group and 0.5% bupivacaine 2ml in BP group.Results The oneset time of sensory and motor blocks in RP group were longer than that of BP group,the height of sensory block and the degree of motor block in RP group were lower than that of BP group, the duration of motor block in RP was shorter than that of BP,the duration of sensory block of the two groups were not siginificantly different.All patients were not used epidural anaesthesia additionally and completed surgery safely and satisfactorily.Conclusion 0.5% ropivacaine of combined epidural anaesthesia is the safe choice in the anus intestine disease operation Key words:ropivacaine;bupivacaine; combined spinal epidural anaesthesia 本实验选用0.5%罗哌卡因应用于腰硬联合麻醉，观察其对肛门会阴区阻滞完善程度，平面的扩散，最大阻滞平面，最大阻滞时间，并与布比卡因相比较，为临床肛肠手术麻醉选用药物提供理论依据。 1.临床资料 1.1一般资料 随机选择肛肠科手术患者48例，年龄20～70岁，ASAⅠ～Ⅱ，排除体质量＜40Kg，＞100Kg者。随机将患者分成罗哌卡因组（RP）、布比卡因组（BP），每组24例。RP组：10g/L罗哌卡因1ml+9g/LNaCl1ml配成0.5%罗哌卡因轻比重液；BP组：0.5%布比卡因溶液2ml。 1.2麻醉方法 患者入室建立静脉通道输注林格式液,监测血压、心电图、心率、血氧饱和度，取左侧卧位，腰3-4间隙穿刺，脑脊液流出后，以0.1ml/s速度分别推注0.5%罗哌卡因液或0.5%布比卡因溶液2ml。之后向上置入硬膜外导管3cm。观察并记录生命体征及麻醉平面。 1.3监测指标 针刺法测试感觉阻滞平面，改良Bromage法[1]评定运动阻滞。30min内每隔2.5min测定1次，以后每隔15min测定1次，直至感觉和运动完全恢复。分别记录感觉阻滞起效时间、最高感觉阻滞平面、感觉阻滞持续时间，运动阻滞起效时间，最大运动阻滞程度（Broma