小剂量低浓度罗哌卡因与布比卡因蛛网膜下腔阻滞在混合痔术中的效果比较

摘要

Objective To observe and compare the anesthetic effects of small-dose and low-concentration ropivacaine hydrochloride and bupivacaine in spinal subarachnoid block (lumbar anesthesia) for mixed hemorrhoid surgeries. Methods Sixty patients who would be undergone mixed hemorrhoid surgeries in our hospital from July to December 2014,in ASAⅠ to II were evenly divided into two groups by random number table.Each group was carried out lumbar anesthesia through interspace between L3 and L4.In groupⅠ,0.25% ropivacaine hydrochloride in 7.5 mg was applied, while in group II,0.25% bupivacaine in 7.5 mg was adopted.The sensory block (by acupuncture),intraoperative rectal stretch reflex,the number of surgical patients evaluating relaxation of anal tube at the beginning of surgery,duration of anal tube relaxation,and recovery rate of anal contraction at the end of surgery was observed between two groups re-spectively. Results The level of sensory block in group Ⅰ was lower than that in group II,with a statistical difference (P<0.05).The reflectance of intraoperative rectal stretch in group Ⅰ was higher in comparison with that in group II, with a statistical difference (P<0.05).There was no statistical difference in satisfaction of anal tube relaxation at the be-ginning of surgery between two groups(P>0.05).The recovery time of anal contraction in group Ⅰ was(45±6) min,higher than that in groupII. Conclusion Both 0.25% ropivacaine hydrochloride in 7.5 mg and the same dose and concentra-tion of bupivacaine in spinal subarachnoid block for mixed hemorrhoid surgeries obtain favorable effects,and the former one used for spinal subarachnoid block can facilitate mixed hemorrhoid surgery,which is worthy of promotion.%目的：观察比较小剂量低浓度盐酸罗哌卡因和布比卡因蛛网膜下腔阻滞(腰麻)用于混合痔手术的麻醉效果。方法选择2014年7~12月本院拟行混合痔手术患者60例，ASAⅠ~Ⅱ级，采用随机数字表法，分为Ⅰ组和Ⅱ组，每组30例。各组分别经L3-4间隙行腰麻。Ⅰ组采用0.25%盐酸罗哌卡因7.5 mg，Ⅱ组采用0.25%布比卡因7.5 mg。观察两组感觉阻滞(针刺法)、术中直肠牵拉反射，术者手术开始评估肛管松弛例数，肛管松弛持续时间，术毕肛门收缩恢复率。结果感觉阻滞平面Ⅰ组低于Ⅱ组，两组差异有统计学意义(P<0.05)；Ⅰ组术中直肠牵拉反射率高于Ⅱ组(P<0.05)；手术开始肛管松弛满意率Ⅰ组与Ⅱ组比较，差异无统计学意义(P>0.05)，肛门收缩运动恢复时间Ⅰ组(45±6)min，术毕肛门收缩运动恢复率Ⅰ组高于Ⅱ组。结论0.25%罗哌卡因7.5 mg与相同浓度剂量布比卡因蛛网膜下腔阻滞用于混合痔手术均获得满意效果，0.25%罗哌卡因7.5 mg用于蛛网膜下腔阻滞可为满足混合痔手术提供便利条件，值得推荐。