罗哌卡因用于硬膜外麻醉在经皮椎间孔镜手术中的浓度效应  

The concentration effect of epidural ropivacaine for percutaneous transforaminal endoscopic discectomy

作　　者：刘涛[1] 戚洪亮[1] 王成 王艳[1] LIU Tao;QI Hong-;WANG Cheng;WANG Yan(Department of Anesthesiology,the 105th Hospital of the Chinese People’s Liberation Army,Hefei,Anhui,230031,China)

机构地区：[1]解放军105医院麻醉科,安徽合肥230031

出　　处：《颈腰痛杂志》2018年第4期458-460,共3页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨罗哌卡因用于硬膜外麻醉在经皮椎间孔镜椎间盘切除手术中的浓度效应。方法选择2017-02-2017-11期间我院接受经皮椎间孔镜手术的成年患者120例,随机分为4组:0.30%罗哌卡因组(R1组,n=30)、0.20%罗哌卡因组(R2组,n=30)、0.10%罗哌卡因组(R3组,n=30)和2%利多卡因浸润局麻组(L组,n=30),硬膜外穿刺点选择椎间盘突出椎体上方第4个间隙,尾向置管4 cm。患者平卧位后经硬膜外导管分3次给予罗哌卡因5 ml、7 ml和8 ml,L组分层浸润麻醉。观察并记录手术期间的心率(HR)、平均动脉压(MAP)、视觉模拟疼痛评分(VAS)和下肢肌张力。结果与术前比较,四组间HR和MAP无统计学差异;术中患者VAS评分比较,R1组较R3组和L组低(P<0.05),R2组较R3低(P<0.05),而R1、R2和L组三组比较无统计学差异(P>0.05);术中患者下肢肌张力比较,R1组较R2、R3组明显差(P<0.05)。结论罗哌卡因用于硬膜外麻醉在经皮椎间孔镜手术中的适宜浓度为0.20%。Objective To investigate the concentration effect of epidural ropivacaine for percutaneous transforaminal endoscopic discectomy. Methods One hundred and twenty adults patients with lumbar disc herniation undergoing elective percutaneous transforaminal endoscopic discectomy were enrolled between February and November 2017 in our hospital, and they were randomly divided into 4 groups： group R1, group R2 and group R3 received epidural ropivacaine at 0.3%, 0.2%, and 0.1%, respectively; group L received a local infiltration of the surgical wound with 2.0% lidocaine, with 30 cases in each group. The epidural anesthesia technique was performed at the intervertebral space above the lumbar disc herniation as puncture site with the patients in the left lateral decubitus position, and an epidural catheter was threaded 4 cm caudal into the epidural space and secured; three doses of 5ml,7ml and 8ml ropivacaine of respective concentration of each group was given as total drug for epidural top up; intraoperative hemodynamic parameters, visual analogue scale（VAS） and legs motor function were investigated. Results There were no significant differences among four groups in mean arterial pressure and heart rates. The VAS during surgery was lower in group R1 than in group R3 and group L （P〈0.05）, and the VAS was lower in group R2 than in group R3 （P〈0.05）, no significant difference of VAS was observed between the group R1 and group R2 during surgery （P〉0.05）. The legs motor function was significantly worse in group R1 than in groups R2 and R3（P〈0.05）. Conclusion The suitable concentration of epidural ropivacaine for percutaneous transforaminal endoscopic discectomy is 0.20%.

关 键 词：罗哌卡因 硬膜外麻醉 经皮椎间孔镜手术 适宜浓度 

分 类 号：R614.42[医药卫生—麻醉学]