低浓度罗哌卡因腰麻用于肛肠手术的临床研究

摘要

目的：比较0.3%、0.25%，0.2%三种浓度罗哌卡因腰麻用于肛肠手术的临床效果。方法整群选取该院2014年12月—2015年6月收治的择期肛肠手术患者共60例，ASAⅠ～Ⅱ级，随机分为3组，每组20例。用25G腰穿针（针内针）行蛛网膜下腔穿刺，于L3～4刺入蛛网膜下腔,注入重比重局麻药3mL（A组0.3%罗哌卡因9 mg，B组0.25%罗哌卡因7.5 mg，C组0.2%罗哌卡因6 mg）。观察记录3组的麻醉效果及不良反应情况。结果感觉运动起效时间3组差异无统计学意义（P＞0.05）,感觉运动维持时间A组＞B组＞C组，3组相比差异均有统计学意义（P＜0.05）；运动阻滞程度在术毕时A组大于B组和C组,差异有统计学意义(P＜0.05),而B组和C组差异无统计学意义(P＞0.05)。 B组与C组低血压的发生率少于A组，差异有统计学意义(P＜0.05)；而B组的牵拉反应少于C组，差异有统计学意义(P＜0.05)。结论0.25%罗哌卡因是用于肛肠手术腰麻的合适浓度，循环稳定，不良反应少。%Objective To compare the clinical effect of three concentration ropivacaine of 0.3%, 0.25%, 0.2% for spinal anesthesia in anorectal surgery. Methods 60 cases of patients prepared for anorectal surgery admitted in our hospital from December 2014 to June2015 and graded by American Anesthesia Association (ASA) in classⅠor classⅡwere randomly di-vided into three groups with 20 cases in each. 25G spinal needle for subarachnoid puncture and stabbed into the subarach-noid space at L3~4, with injection of 3ml hyperbaric local anesthetics (A group 0.3%ropivacaine 9mg;B group 0.25%ropi-vacaine 7.5mg; C group 0.2% ropivacaine 6mg).The anesthetic effect and adverse reactions of the three groups were ob-served. Results There was no statistically significant difference in the onset time of sensory and motor between the three groups (P>0.05).The maintain time of sensory and motor: group A>group B> group C, the difference between the three groups was statistically significant(P<0.05).The degree of motor block in group A was significantly higher than that in group B and group C at the end of surgery, the difference was statistically significant (P<0.05),while there was no significant dif-ference between group B and group C (P>0.05).The incidence of hypotension in group B and group C was less than that of group A, the difference had statistical significance (P<0.05),while group B had less draw reaction than group C, the differ-ence had statistical significance(P<0.05). Conclusion 0.25% ropivacaine was suitable concentration for spinal anesthesia in anorectal operation with better cycle stability and less adverse reaction.