轻比重罗哌卡因单侧腰麻用于单侧下肢创伤手术对PCEA的影响

目的 观察轻比重罗哌卡因单侧腰麻用于下肢创伤手术患者的麻醉效果及其对硬膜外自控镇痛(PCEA)的影响.方法 ASA Ⅰ或Ⅱ级下肢创伤手术患者120例,随机均分为L1、L2、W1、W2四组.L1、L2组分别用轻比重罗哌卡因7.5～15.0 mg、15.0～22.5 mg,W1、W2组分别用重比重罗哌卡因7.5～15.0 mg、15.0～22.5 mg.术后用罗哌卡因150 mg+舒芬太尼0.05 mg+阿扎司琼10 mg+生理盐水至100 ml行PCEA.记录两组麻醉效果、不良反应,术始、术中及PCEA结束时双下肢的Bromage评分.结果 L1、L2、W2组麻醉效果优于W1组(P＜0.05).L1、L2组感觉、运动阻滞起效时间明显短于W1、W2组(P＜0.05).L1组各时点健肢Bromage评分明显低于患肢(P＜0.05).L1组低血压、尿潴留发生率明显低于L2、W2组(P＜0.05).结论 下肢创伤手术使用0.3％轻比重罗哌卡因7.5～15.0 mg单侧腰麻,麻醉效果满意,术后PCEA期间运动阻滞仅限于患肢,血流动力学稳定,不良反应发生率低,患者总体满意度高.

Application of hypobaric ropivacaine in unilateral spinal anesthesia in patient undergoing lower limb traumatic operation and its effect on patient-controlled epidural analgesia

Objective To observe the effect of unilateral spinal anesthesia with hypobaric ropivacaine on patient undergoing lower limb traumatic operation,and its influence on patient-controlled epidural analgesia.Methods One hundred and twenty patients undergoing lower limb traumatic operation were divided randomly into four groups.Patients in group L1 or group L2 received hypobaric ropivacaine 7.5-15.0 mg or 15.0-22.5 mg respectively,while patients in group W1 and group W2 were administered hyperbaric ropivacaine 7.5-15.0 mg and 15.0-22.5 mg respectively.Patient-controlled postoperative epidural analgesia consists of ropivacaine 150 mg,sufentanial 0.05 mg.The anesthetic effect and Bromage score were recorded.Results Patients in group L1,group L2 and group W2 achieved satisfactory block.Sensory and motor nerve block onset time in group L was shorter than those in group W.Obviously,the Bromage score of either lower limb in group L1 were different,the score of right side were lower than those the broken one.The incidence of hypotension and uroschesis in group L1 were lower than that in group L2 and group W2 (P<0.05).Conclusion Application of 0.3% hypobaric ropivacaine in unilateral spinal anesthesia in patient undergoing lower limb traumatic operation provided rapid onset,more satisfactory sensory block with less hemodynamic changes and less complications.The motor block was also limited in the operative side limb after received patient-controlled postoperative epidural analgesia.