不同浓度罗哌卡因腰麻-硬膜外联合麻醉对经皮肾镜碎石术患者术中血流动力学的影响研究

摘要

目的 探讨不同浓度罗哌卡因腰麻-硬膜外联合麻醉(CSEA)对经皮肾镜碎石术(PCNL)患者术中血流动力学的影响.方法 纳入2016年1至12月择期行PCNL患者180例作为研究对象,均行CSEA,根据罗哌卡因用药浓度分为0.375%组、0.500%组、0.750%组,每组各60例,比较3组感觉、运动阻滞情况,记录麻醉前(T0)、蛛网膜下腔麻醉后10min(T1)、俯卧位后硬膜外给药前(T2)、俯卧位后硬膜外给药10min(T3)、给药30min(T4)、给药60min(T5)点时平均动脉压(MAP)、心率(HR)变化,并统计麻醉相关不良反应.结果 3组最高感觉间阻滞平面、感觉阻滞起效时间比较差异无统计学意义(P>0.05),但0.375%组运动阻滞起效时间长于0.500%组、0.750%组,其感觉阻滞恢复时间、运动阻滞恢复时间均短于0.500%组、0.750%组,差异有统计学意义(P<0.05),且0.500%组、0.750%组感觉阻滞恢复时间、运动阻滞起效时间及恢复时间比较,差异有统计学意义(P<0.05);与T0点比较,0.375%组T 2~4点时HR下降(P<0.05),0.50%组、0.750%组T 2~4点MAP、HR均下降(P<0.05);0.375%组T2~4点时MAP、HR均明显低于0.750%组(P<0.05),但0.375%组与0.500%组、0.500%与0.750%组相同时间点MAP、HR比较,差异无统计学意义(P>0.05);3组麻醉相关不良反应比较差异无统计学意义(P>0.05).结论 0.375%罗哌卡因CASE既可满足PCNL手术麻醉需求,又可减少对术中血流动力学的影响.%Objective To investigate the effect of different concentrations of ropivacaine combined spinal-epidural anes-thesia (CSEA) on intraoperative hemodynamics in patients undergoing percutaneous nephrolithotripsy (PCNL).Methods From January 2016 to December2016,180 patients with PCNL were included in the study,which were all treated with CSEA. According to the concentration of ropivacaine,they were divided into 0.375% group,0.500% group and 0.750% group,60 cases in each group.The sensation and motor block of the three groups were compared. Changes of mean artery pressure(MAP) and Heart rates (HR)at before anesthesia(T0),10 minutes after subarachnoid anesthesia(T1), before epidural administration in prone position (T2)and 10 minutes after epidural administration in prone position(T3),30 minutes after administration(T4), and 60 minutes after administration(T5)were recorded.And anaesthesia related adverse reactions were counted.Results There was no significant difference in the highest level of intersensory block and the onset time of sensory block in the three groups(P>0.05),but the on-set time of motor block in group 0.375% was longer than that in group 0.500% and group 0.750%,while the recovery time of sensory block and motor block in this group were shorter than that in group 0.500% and group 0.750% (P<0.05),and the com-parison of recovery time of sensory block,onset time and recovery time of motor block between group 0.500% and group 0.750% were significantly different(P<0.05);Compared with T 0,the HR of group 0.375% decreased atT 2~4(P<0.05),and the MAP and HR of group 0.50% and group 0.750% both decreased at T 2~4(P<0.05);The MAP and HR of group 0.375% were signifi-cantly lower than those of group 0.750% at T2~4(P<0.05),but there was no significant difference of MAP and HR between group 0.375% and group 0.500%,group 0.500% and group 0.750% at the same time point(P>0.05);no significant differ-ence in anaesthesia related adverse reactions among the three groups (P>0.05).Conclusion 0.375% ropivacaine CASE can not only meet the anesthetic requirement of PCNL,but also reduce the effect of hemodynamics during operation.