小剂量重比重与轻比重罗哌卡因单侧蛛网膜下腔阻滞效果的比较  

Comparison of the block effect between weighty and light specific gravity of low dose ropivacaine for unilateral subarachnoid block in lower extremity operation

作　　者：王铁军[1] 张大志[1] 冯磊[1] 杨庆国[1] 李世忠[1] 

机构地区：[1]北京大学医学部第四临床医学院北京积水潭医院麻醉科,100035

出　　处：《北京医学》2008年第9期533-535,共3页Beijing Medical Journal

摘　　要：目的比较小剂量重比重与轻比重盐酸罗哌卡因行单侧蛛网膜下腔阻滞用于下肢短小手术的神经阻滞效果。方法选择年龄18～60岁、ASAⅠ～Ⅱ级、拟行下肢短小手术患者60例,随机分为重比重(W)与轻比重(L)两组,每组30例。W组患肢向下侧卧,L3～4椎间隙穿刺成功后将重比重于15s内缓慢注入蛛网膜下腔,5min后平卧测定阻滞平面;L组患肢向上侧卧,L3～4椎间隙穿刺成功后将轻比重罗哌卡因于15s内缓慢注入蛛网膜下腔,5min后平卧测定阻滞平面。观察两组罗哌卡因单侧蛛网膜下腔感觉、运动神经阻滞效果,术中监测生命体征,术后随访并发症。结果W组感觉神经阻滞起效、平面固定时间分别为(1.55±0.15)、(13.4±4.2)min,明显短于L组的(2.12±0.65)、(22.5±3.4)min(P﹤0.01),感觉阻滞持续时间W组为(107.5±12.6)min,明显长于L组的(75.4±15.5)min(P﹤0.001)。W组患侧阻滞平面均达到T12～T10,感觉神经阻滞完善,健侧阻滞平面均在L2以下;L组患侧仅70%患者阻滞平面在T12～T10,健侧阻滞平面在T11以下,较W组平面高,有9例患者需硬膜外追加0.5%罗哌卡因完成手术;两组术中NIBP、SpO2、ECG、HR等生命体征平稳,术后随访均无头痛、恶心、呕吐及尿潴留等并发症。结论小剂量重比重罗哌卡因单侧蛛网膜下腔阻滞麻醉,感觉神经阻滞成功率高,对血流动力学影响小,安全可靠且并发症少,对住院、门急诊、老年患者行下肢短小手术有临床应用价值。Objective To compare the effect of low dose weighty specific gravity with light specific gravity of ropivacaine for unilateral subarachnoid block in lower extremity operation. Methods 60 ASA Ⅰ-Ⅱ adults aged from 18 to 60 years and scheduled for elective lower extremity operation were randomly divided into two groups：light specific gravity group （group L） and weighty specific gravity （Group W）. Each group had 30 patients. Group L was given 0.75ml of 1% ropivaeaine with 2.25ml water for injection and the affected limb was upward when lumbar puncture;Group W was given 1% ropivacaine 0.75ml combined with 5% glucose 2.25ml and the affected limb was downward. Puncture point was chosen on L3-4. The injecton was finished in 15s and the block plane was determined after 5 minutes. The onset time and duration, the upper plane of analgesia and fixation time degree of motor block were observed and complications were followed up after operation. Results Compared with Group L, the onset time and fixation time in group W were shorter but the duration was longer（P 〈 0.01）. The upper plane of analgesia on affected limb was T10-12 and uninjured side were below I.,2 in Group W, but there was only 70% patients whose upper plane of analgesia on affected limb was T10-12 in Group L（P 〈 0.05）. Nine patients in Group L needed epidural injection with 0.5% ropivacaine for unsatisfactory anesthesia while the effect was satisfied in Group W （P 〉 0.05）. There were no complication in both groups. Conclusions Low dose weighty specific gravity of ropivacaine for unilateral subarachnoid,block is safe and effective in lower extremity operation.

关 键 词：小剂量 比重 罗哌卡因 蛛网膜下腔下肢手术 

分 类 号：R614[医药卫生—麻醉学]