应用不同比重罗哌卡因单侧腰麻对下肢手术麻醉效果的比较性观察  

The comparative observation on anesthesia effect from unilateral spinal anesthesia with hypobaric ropivacaine and hyperbaric ropivacaine solution in lower limbs operations

作　　者：赵文宝[1] 万磊[2] 李彦平[2] 王强[3] 

机构地区：[1]北京市丰台区医院麻醉科,北京100071 [2]首都医科大学附属北京友谊医院麻醉科,北京100050 [3]北京博爱医院麻醉科,北京100068

出　　处：《临床和实验医学杂志》2014年第11期934-937,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的对比观察应用轻比重罗哌卡因和重比重罗哌卡因进行单侧蛛网膜下腔麻醉的临床效果。方法随机选择骨科择期行膝关节置换术手术病人60例，ASAⅡ～Ⅲ级。随机分为两组。轻比重组（n=30）给予11．25mg的罗哌卡因（7．5mg／ml）＋2ml的蒸馏水；重比重组（n=30）给予11．25mg的罗哌卡因（7．5mg／ml）＋2ml（5mg／ml）的葡萄糖。轻比重组患者拟手术侧肢体（患肢）在上侧卧位，手术床头高低脚斜15°；重比重组病人拟手术侧肢体（患肢）向下侧卧位，手术床头低脚高倾斜15°。选择L3-4间隙行腰硬联合麻醉。观察指标包括：围麻醉期血液动力学等检测指标、脊神经麻醉相关监测参数、麻醉恢复时间、麻醉成功率、病人及手术医生满意度。结果①手术侧和非手术侧两组麻醉平面达到T10水平的时间比较，结果显示重比重组的时间明显短于轻比重组（P〈0．05）。②两组阻滞后，重比重组侧卧时达到单侧完全阻滞的病人显著低于轻比重组（P〈0．05）。③手术侧和非手术侧两组麻醉后感觉平面消退2个脊髓节段的时间比较显示，轻比重组明显短于重比重组（P〈0．05）。④两组无因腰硬联合麻醉失败实施全身麻醉病例，麻醉过程中无因病人不适或烦躁应用镇静药物，所有病人手术侧麻醉阻滞脊髓节段均达到T10水平；麻醉过程中血液动力学检测数据显示两组无统计学差异。⑤两组麻醉质量及病人和手术医生满意度比较，结果显示无统计学差异（P〉0．05）。结论蛛网膜下腔麻醉应用重比重罗哌卡因和轻比重罗哌卡因均可达到膝关节置换手术完善和可靠的麻醉效果，满意度高。轻比重局麻药可以提供高水准的单侧麻醉，且感觉和运动阻滞的恢复较快，因此更适合于老年患者的手术后肢体早期运动，减少血管并发症的发生。Objective To compare the clinical effect between lateral spinal anesthesia （LSA） with hypobaric ropivacaine solution （HoRS） and LSA with hyperbaric mpivacaine solution （HpRS）. Methods Sixty patients whose physical condition were II or III according to the classification of American Association of Anesthesiologist （ASA） and who would accept total knee arthroplasty （TKA） were randomly divided into groups of receiving ropivacaine 11.25mg （7.5 mg/ml） and 2ml distilled water （group A, hypobaric solution, n = 30）, and ropivacaine 11.25 mg （7.5 mg/ml） and 2 ml glucose solution （5 mg/ml） （group B, hyperbaric solution, n =30）. Their affected limbs were upward and they were in head - up tilt at 15 degree lateral position when HoRS was used and affected limbs were downward and they were in foot - up tilt at 15 degree lateral position when HpRS was used in spinal anesthesia. The puncture site for combined spinal and epidural anesthesia （CSEA） was chosen in intervertebral space between No. 3 and No. 4 vertebral body. Monitoring items including hemodynamics, anesthesia parameters, anesthesia recovery time, anesthesia success index, and satisfaction index （SI） from patients and doctors were observed. Results Patients with HpRS in spinal anesthesia had shorter time to get T10 anesthesia level in affected or non - affected limbs than that in patients with HoRS （ P 〈 0.05 ）. The number of patients who had unilateral anesthesia at lateral position with HpRS was smaller than that with HoRS （ P 〈 0.05 ）. Patients with HoRS in spinal anesthesia had shorter time to reduce two spinal segments of anesthesia level than that in patients with HpRS （ P 〈0.05 ）. No patient was found to be in unsuccessful CSEA and a general anesthesia was needed in both groups. No sedatives were needed during the operation in both groups. All patients had T10 anesthesia level at the affected limbs. There was no significant difference in hemodynamics and SI from patients and doctors between two g

关 键 词：单侧腰麻 蛛网膜下腔阻滞 重比重罗哌卡因 轻比重罗哌卡因 

分 类 号：R614[医药卫生—麻醉学]