罗哌卡因轻比重蛛网膜下腔阻滞在临床中的应用与研究  

Application and Study of Ropivacaine in Light Specific Gravity Spinal Block

作　　者：杨文奎[1] 吕玲[2] 温东辉[1] 

机构地区：[1]沈阳医学院附属第二医院麻醉科,辽宁沈阳110002 [2]沈阳医学院外科教研室

出　　处：《沈阳医学院学报》2004年第2期71-72,共2页Journal of Shenyang Medical College

摘　　要：目的:研究罗哌卡因在轻比重蛛网膜下腔阻滞的可行性、有效性和安全性。方法:选择单侧肾、输尿管结石、肾囊肿、肾肿瘤手术120例,年龄16-60岁,ASA Ⅰ-Ⅱ级。随机分成两组,用1％罗哌卡因2 ml(0.3 mg/kg)加8 ml注射用水,加0.1％肾上腺素0.2 ml总剂量10ml。0.75％布比卡因2 ml(O.25 mg/kg)加8 ml注射用水,加0.1％肾上腺素0.2 ml,总剂量10 ml。患者平卧位时测血压、脉搏、呼吸、血氧、心电。随后患侧向上侧卧住,用普通穿刺针行腰3-4椎间穿刺,脑脊液流出,证明在蛛网膜下腔,穿刺针斜面向上缓慢推注罗哌卡因或布比卡因。推药时间为30 s。1 min开始测试患者的感觉、运动阻滞起效时间并记录阻滞持续时间及消退时间。并观察用药后的不良反应及BP、HR、RR、SaO2、ECG,以便做相应处理。术后随访一次,记录术后不良反应,对观察相关资料做统计学处理。结果:罗哌卡因起效时间与布比卡因无统计学差异(P>0.05),阻滞持续时间短于布比卡因(P<0.01)。主要不良反应为恶心、呕吐,术中血压不降,术后头痛差异无显著性(P>0.05)。结论:罗哌卡因轻比重蛛网膜下腔神经阻滞用于单侧泌尿科手术操作简单,明显缩短麻醉及摆体位时间。麻醉效果确切,与布比卡因一样只要及时处理麻醉中出现的并发症,不失为一种安全可行的麻醉方法。Objective: To study operation, efficacy and safety of Ropivacaine in light specific gravity spinal block. MethodS:120 cases with unilateral kidney and ureteral calculus,renal tumor and cyst were chosen. These cases who age from 16-60,ASA in Ⅰ-Ⅱ class,were divided into 2 groups. Croup 1 was given 1% Ropivacaine 2ml (0.3mg/kg) adding injection water 8ml and 0. 1% Adrinaline 0. 2ml. Croup 2 was given 0. 75% Bapivacaine 2ml (0.25mg/kg) , adding Injection water 8ml and 0.1% Adrinaline 0.2ml. Total dose is 10ml in enery group. The patients' BP, HR,RR,SaO2 and ECC were examined before puncture. Puncture point was chosen in L3- L4. The hode of the puncture needle was up. The drugs was injected slowly at 30 second. The patient's peval were tested and onset time of sensory ,movement block after injection 1 min and the recovering time were recorded. During the time, the side efficacy,HR,RR,SaO2 and ECG were observated and manage on time. After operatin,the anestlesist visited patients 1 -2 time for observating and treating side efficacy. The material of statitus was mamaged. Results:There were no difference in level and onset time of sensory block between Ropivacaine and Bupivacaine( P>0.05). Nerve block time of Ropivaaine was shorter than Bupivacaine ( P < 0. 01). There were no significant difference in side efficacy (nausea,vomting and headache) between Ropivacaine and Bupivacaine( P > 0.05). Conclusion: Ropivacaine in light specific gravity spinal block was used in unilateral kidney and urinary tract operation which was single and quick in operation. This anesthetic method was more satisfactory and muscle relaxation was as better as Bupivacaine if the side efficacy was treated on time. It should be more safety and effective anesthetic method.

关 键 词：轻比重罗哌卡因 蛛网膜下腔阻滞 可行性 有效性 麻醉 安全性 

分 类 号：R614.4[医药卫生—麻醉学] R971.2[医药卫生—外科学]