布比卡因等比重液腰麻-硬膜外联合阻滞用于直肠癌根治手术  

Clinical study of combined spinal-epidural anesthesia with isobaric solution bupivacaine used in patients undergoing rectocancertomy

作　　者：王立文[1] 郭永军[1] 马秀光[1] 梁华[1] 杨向荣[1] 杨焕杰[1] 马彩军 

机构地区：[1]解放军第五医院,宁夏银川750004

出　　处：《宁夏医学杂志》2002年第2期77-78,共2页Ningxia Medical Journal

摘　　要：目的　研究应用布比卡因等比重液腰麻 -硬膜外联合阻滞用于直肠癌根治手术的安全性和有效性。方法　选择经腹会阴联合切口直肠癌根治手术病人 6 2例 ,34- 75岁 ,ASAⅠ -Ⅱ级。采用两点穿刺 ,先于T10 -12间隙硬膜外穿刺并头端置入硬膜外导管 ,后用 7号腰穿针于L2 -3 间隙穿刺 ,有脑脊液流出后 ,以 0 .1ml/s的速度蛛网膜下腔注入 0 .75 %布比卡因 2 - 2 .2ml,进腹后酌情硬膜外腔追加 2 %利多卡因或 2 %利多卡因 - 0 .75 %布比卡因混合液 ,平均用药量 (11.70± 2 .6 3)ml。术中适当使用镇静镇痛药物 ,并观察麻醉效果、作用时间、呼吸和循环功能变化。结果　蛛网膜下腔注入布比卡因后 ,药物起效时间为 1- 3分钟 ,麻醉平面固定时间为 10 - 15分钟 ,阻滞平面达T3 -5-S5。手术时间为 (192 .0 0± 2 6 .5 8)分钟 ,术后镇痛时间达 2 - 3h。腰麻后 15分钟呼吸循环功能各项变化不明显 (P >0 .0 5 ) ,麻醉后 30分钟与麻醉前比较 ,SBP降低具有非常显著性差异 (P <0 .0 1) ,DBP下降差异有统计学意义 (P <0 .0 5 ) ,经快速输液或给予麻黄碱即可纠正。本组麻醉均获成功 ,无失败病例 ,术后发生头痛 1例 ,自行缓解 ,无其它严重麻醉并发症。结论　 0 .75 %布比卡因等比重液腰麻 -硬膜外联合阻滞麻醉用于直肠癌根治手术麻醉?Objectives The study was designed to determine clinical efficacy and safety of isobaric bupivacaine for combined spinal-epidural anesthesia during rectocancertomy.Methods Sixty-two patients,ASA class Ⅰ-Ⅱ,34-75 years,undergoing elective retocancertomy.Two point spinal punctured,epidural was applied at the T 10 12 interspace,subarachnoid anesthesia was performed at L 2-3 interspace in the lateral position,using a 7gauge spinal needle,to receiving spinally isobaric solution 2-2.2ml of 0.75% bupivacaine,and anesthesia was maintained with epidural administratoin with 2% lidocaine or compound 2% lidocaine-0.75% bupivacaine if necessary.SBP?DBP?HR and SPO 2 were monitored during operatoin.Results The onset was 1-3 min and level of the block was at the T 3-5 -S 5 of spinal anesthesia.After injecting local anesthetic in subarachnoid 30 min compare with base ualve,SBP and DBP were decreased statistically(P<0.01 or P<0.05),there were no significantly of HR and SpO 2 were changed(P>0.05).The everage dose was 11.70±2.36ml of epidural drugs.All patients no serious complication after anesthesia and surgery. Conclusions 0.75% bupivacaine is safe and effective for combined spinal-epidural anesthesia during rectocancertomy.

关 键 词：布比卡因 等比重液 腰麻-硬膜外联合麻醉 直肠癌 外科手术 

分 类 号：R614.42[医药卫生—麻醉学]