不同剂量舒芬太尼复合微小剂量罗哌卡因可行走腰麻在肛肠手术中的应用研究

摘要

目的：观察不同剂量舒芬太尼复合微小剂量的罗哌卡因可行走腰麻用于肛肠手术麻醉效果及可行性。方法选取300例肛肠手术患者， ASAⅠ～I 级，按照随机数字表法分成3组：R组（100例），1%罗哌卡因0.3 mL（3 mg）；RF 1组(100例),1%罗哌卡因0.3 mL（3 mg），复合舒芬太尼2.5μg；RF 2组(100例)，1%罗哌卡因0.3 mL（3 mg），复合舒芬太尼5μg。各组均用生理盐水稀释至4 mL行L 3/4椎间隙鞘内注射。观察麻醉后不同时点肛周针刺疼痛vas评分，疼痛消失起效时间及维持时间，下肢运动改良Bromage评分。并观察恶心呕吐、低血压、皮肤瘙痒、尿潴留等不良反应。结果3组随着复合舒芬太尼剂量的增加，VAS评分逐步下降（P＜0.05），随着复合舒芬太尼剂量的增加，起效时间逐步缩短（P＜0.05），且疼痛消失的维持时间逐步延长（P＜0.05），3组都对下肢运动阻滞轻微，几乎都不影响下肢运动功能，可行走率为100%。各组不良反应发生率中，除皮肤瘙痒随着复合舒芬太尼剂量增加而升高外（P＜0.05），恶心呕吐、低血压、尿潴留的发生率都极低，差异无统计学意义。结论1%罗哌卡因0.3mL（3mg），复合舒芬太尼5μg稀释至4 mL行L 3/4椎间隙鞘内注射，痛觉阻滞完善、对下肢运动阻滞几乎无影响，不良反应发生率低，用于肛门直肠手术有一定的临床参考价值。%Objective To observe the effect of different doses of sufentanil combined with small dose of ropivacaine in spinal anesthesia can walk the feasibility and effect of anesthesia in anorectal surgery.Methods To select 300 cases of anorectal surgery patients, ASA I-II. Group R, 1% ropivacaine 0.3mL (3mg); group RF1(3mg), 1% 0.3mL ropivacaine combined with sufentanil 2.5 g; group RF2, 1% ropivacaine 0.3mL (3mg), sufentanil 5 g. All groups were diluted with normal saline and injected into 4mL intervertebral space with L3/4. The VAS score, the onset time and the maintenance time of the onset of pain disappeared, and the improved Bromage score of lower limb movement were observed after anesthesia. Nausea and vomiting, low blood pressure, skin itching, urinary retention and other adverse reactions were observed.Results Of the 3 groups increased with the dose of sufentanil, VAS score decreased gradually (P<0.05), with the increase of sufentanil dose, the onset time shortened gradually (P<0.05), and the duration of pain disappeared gradually extended (P<0.05), 3 groups of lower extremity motor block mild, almost lower extremity motor function are not affected, walking rate was 100%. The adverse reaction rate in each group, except the skin pruritus with sufentanil dose increases increased (P<0.05), the incidence of nausea and vomiting, hypotension and urinary retention were extremely low, the difference was not statistically significant. Conclusion1% ropivacaine 0.3mL (3mg), sufentanil 5 g diluted to 4mL L3/4 intervertebral intrathecal injection, perfect and almostno effect on lower extremity motor block pain block, low incidence of adverse reactions, for anorectal surgery has certain clinical reference value.