轻比重罗哌卡因腰-硬联合麻醉在腰椎间盘切除术中的应用  

Application of spinal anaesthesia with hypobaric ropivacaine for lumbar diskectomy

作　　者：王涛[1] 徐贯杰[2] 赵士强[1] 梁宏云[1] 

机构地区：[1]石家庄市第三医院麻醉科,河北石家庄050011 [2]河北医科大学附属第三医院麻醉科,河北石家庄050051

出　　处：《中国新药与临床杂志》2010年第2期139-142,共4页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的探讨轻比重罗哌卡因腰-硬联合麻醉在腰椎间盘切除术中的应用。方法拟行腰椎间盘切除术患者51例随机分为3组,每组17例。腰麻-硬膜外联合麻醉1组(CSE1组,罗哌卡因10mg5mL,比重0.9865)、腰麻-硬膜外联合麻醉2组(CSE2组,罗哌卡因13mg∶5mL,比重0.9947)、连续硬膜外麻醉组(CE组,0.5%罗哌卡因10～15mL)。注药后均俯卧于有腰桥的手术台上,使手术部位位于最高点。当感觉阻滞平面低于T10时,均经硬膜外追加0.5%罗哌卡因5mL。观察3组感觉、运动阻滞情况,镇痛效果和不良反应。结果感觉阻滞起效和达最高阻滞平面所需时间CSE1组和CSE2组明显快于CE组(P<0.01),CSE1组感觉阻滞维持在T10时间短于CSE2组和CE组(P<0.05),完全运动阻滞持续时间3组比较差异无显著意义(P>0.05)。镇痛效果CSE1组和CSE2组优于CE组(P<0.01)CSE1组和CSE2组间无显著差异(P>0.05)。3组不良反应发生率无显著差异(P>0.05)。结论轻比重罗哌卡因腰-硬联合麻醉可安全用于俯卧位腰椎间盘切除术。AIM To study the application of spinal-epidural anaesthesia with hypobaric ropivacaine for lumbar diskectomy. METHODS Fifty-one patients undergoing lumbar diskectomy were randomly divided into three groups （17 in each） ： combined spinal-epidural anaesthesia group 1 （CSE1, ropivacaine 10 mg ： 5 mL, specific gravity 0.986 5）, combined spinal-epidural anaesthesia group 2 （CSE2, ropivacaine 13 mg ： 5 mL, specific gravity 0.994 7） and continuous epidural anaesthesia group （CE, 0.5% ropivacaine 10 - 15 mL）. After anaesthetic injection, all patients were asked to lay down in prone position on the operation table with lumber bridge. The location of operation was the highest of the operation table. If the level of sensory block was lower than T^o during operation, 5 mL of 0.5% ropivacaine were added epidurally in all groups. Sensory and motor block, analgesic effect and adverse reactions in the three groups were observed. RESULTS The time to initial onset of sensory block and the time to reach the highest level of sensory block in the group CSE1 and group CSE2 were significantly faster than those in the group CE （P 〈 0.01 ）. The duration of sensory block at Tlo of group CSE1 was shorter than the other two （P 〈 0.05）. There was no significant difference among the three groups in the duration of complete motor block （P 〉 0.05）. Analgesic effects in group CSE1 and CSE2 were better than that in the group CE （P 〈 0.01 ）. There were no significant differences among the three groups in the occurrence of adverse reactions （P 〉 0.05） . CONCLUSION Combined spinal-epidural anaesthesia with hypobaric ropivacaine is safe in lumbar diskectomy with prone position.

关 键 词：罗哌卡因 比重 麻醉 硬膜外 麻醉 脊椎 椎间盘切除术 

分 类 号：R971.2[医药卫生—药品]