低浓度罗哌卡因联合小剂量芬太尼在骶管阻滞中的临床应用研究  

Clinical application of low dose of ropivacaine combined with fentanyl in patients undergoing caudal epidural analgesia

作　　者：成龙[1] 张永禄 黄元庆[1] 肖成军[1] 许楷苓 肖茗月 CHENG Long;ZHANG YONG-lu;HUANG Yuan-qing;XIAO Cheng-jun;XU Kai- ling;XIAO Ming-yue(Bazhong Hospital of Traditional Chinese Medicine ,Bazhong District People＇s Hospital, Bazhong 636000, Chin)

机构地区：[1]四川省巴中市中医院.巴州区人民医院,四川巴中636000

出　　处：《实用医院临床杂志》2018年第3期147-149,共3页Practical Journal of Clinical Medicine

摘　　要：目的观察低浓度罗哌卡因复合小剂量芬太尼在骶管麻醉中的效果。方法选择肛门、直肠、会阴部手术患者200例,采用随机数字法分为四组,每组50例,A组:0.45%罗哌卡因+0.5%利多卡因;B组:0.45%罗哌卡因+50μg芬太尼+0.5%利多卡因;C组:0.225%罗哌卡因+0.5%利多卡因;D组:0.225%罗哌卡因+0.5%利多卡因+芬太尼50μg。分别在注药后观察麻醉起效时间、麻醉效果、术后排尿情况、术后运动功能及局麻药中毒的情况。结果 C组麻醉起效时间显著晚于A组和B组,麻醉维持时间显著短于A、B、D三组。D组麻醉维持时间显著短于B组,差异有统计学意义(P均<0.05)。C组术中需要局麻药切口周围浸润的人数显著高于A组,C组和D组患者术后排尿及运动功能明显优于A组和B组,差异有统计学意义(P均<0.05)。结论在骶管阻滞中应用低浓度罗哌卡因复合小剂量芬太尼可缩短麻醉起效时间,增强麻醉效果,延长麻醉镇痛时间,减少术后留置尿管及较少影响患者运动功能。低浓度罗哌卡因复合小剂量芬太尼在骶管阻滞中是安全有效的。Objective To investigate the analgesic effects of low dose of ropivacaine combined with fentanyl in patients undergoing caudal epidural analgesia.Methods We selected 200 patients undergoing anorectal or perineum surgery with caudal epidural anaesthesia as study population.The patients were randomly divided into four groups,50 in each group. Group A received 0. 45% ropivacaine and 0. 5% lidocaine; group B received 0. 45% ropivacaine,0. 5% lidocaine and 50 μg fentanyl; group C received 0. 225% ropivacaine and 0. 5% lidocaine and group D received 0. 225% ropivacaine,0. 5% lidocaine and 50 μg fentanyl.The onset time of intraoperative analgesic,caudal block efficacy,postoperative urinary function,postoperative motor function and side effects were observed.Results The time for onset of sensory block and motor block was longer in the group C as compared with the group A and the group B,and the duration of analgesic maintenance was shorter in the group C as compared with another three groups. The duration of analgesic maintenance in the group D was significantly shorter than the group B. All differences were statistically significant（ all P〈0. 05）. The incidence of additional local infiltration was significantly higher in the group C than in the group A.Urinary function and motor function in the group C and D were better than in the group A and B（ all P〈0. 05）.Conclusion Administration of low dose of ropivacaine combined with low dose fentanyl may reduce the onset time of anesthesia,improve the effect of anesthesia,prolong the analgesia time,ameliorate the postoperative incontinence without affecting the motor function in caudal epidural analgesia.The method is safe and effective in caudal epidural analgesia.

关 键 词：罗哌卡因 芬太尼 骶管麻醉 

分 类 号：R614.4[医药卫生—麻醉学]