不同剂量利多卡因复合罗哌卡因用于硬膜外麻醉的效果比较

目的 比较不同剂量利多卡因复合罗哌卡因用于硬膜外麻醉的效果.方法 选择拟行阑尾切除术的患者120例,随机均分为三组,分别予2％盐酸利多卡因10 mL复合1％盐酸罗哌卡因5mL行硬膜外麻醉(Ⅰ组)、2％盐酸利多卡因7.5 mL复合1％盐酸罗哌卡因7.5 mL行硬膜外麻醉(Ⅱ组)、2％盐酸利多卡因5 mL复合1％盐酸罗哌卡因10 mL行硬膜外麻醉(Ⅲ组).三组患者均选择T12～L1行硬膜外穿刺、置管,注入2％盐酸利多卡因3 mL作为试验剂量,再注入10mL局麻药作为初始量,三组患者在术后进行视觉模拟(VAS)疼痛评分、舒适度(BCS)评分和术者满意度评分(视觉模拟评分,VAS评分)以评价药物治疗效果.监测并记录麻醉起效时间、麻醉不良反应、感觉神经阻滞情况(采用针刺皮肤法)、切皮前运动神经阻滞情况(采用Bromage评分法)以及入室(T0)、术前(T1)、切皮(T2)、术毕(T3)的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)及呼吸频率(R).结果 三组患者R、SpO2比较差异无统计学意义(P＞0.05)Ⅲ组患者MAP低于Ⅰ、Ⅱ组,HR快于Ⅰ、Ⅱ组(P＜0.05)术后VAS疼痛评分Ⅱ、Ⅲ组低于Ⅰ组(P＜0.05),BCS评分Ⅱ组高于Ⅰ、Ⅲ组(P＜0.05).Ⅰ、Ⅱ组感觉阻滞起效时间、达最高平面时间显著短于Ⅲ组(P＜005),切皮前Ⅱ、Ⅲ组运动神经阻滞程度优于Ⅰ组(P＜0.05).Ⅰ、Ⅱ组麻醉起效时间短于Ⅲ组(P＜0.05)Ⅱ、Ⅲ组术者满意度优于Ⅰ组(P＜0.05).结论 2％盐酸利多卡因7.5 mL复合盐1％酸罗哌卡因7.5 mL行硬膜外麻醉的效果优于其他组.

Comparison of effects of different concentrations of lidocaine hydrochloride combined ropivacaine hydrochloride in epidural anesthesia

Objective To compare the effects of different concentrations of lidocaine hydrochloride combined ropiva- caine hydrochloride in epidural anesthesia. Methods 120 patients undergoing appendectomy were selected anti randomly divided into three groups with 40 cases in each group. 2% lidocaine hydroehloride 10 mL combined 1% ropivacaine hydrochloride 5 mL was given for epidural anesthesia in the group ] , 2% lidocaine hydrochloride 7.5 mL combined 1% ropivacame hydrochloride 7.5 mL in the group II and 2% lidocaine hydrochloride 5 mL combined 1% ropivacaine hydrochloride 10 mL in the group 11I. Three groups all applied epidural anesthesia, punctured in T2-L1, put catheter,injected 2% lidocaine hydrochlol4de 3 mL as test dose into epidural space,then injected local anesthetic 10 mL as initial dose. The visual analogue scale （VAS I of postoperative pain, the Brurggmann comfort scale （BCS） and the satisfaction of physicians （VAS） were compared among three ：~oups. The inci- dence of side effects, sensory nerve block state （applied acupuncture skin method ）and motor nerve block state before cutting skin （graded by Bromage） were recorded. HR, MAP and SpO2 were recorded before operation （To）, in skin incision （Tj）, at the end of operation （T2）. Results The R and SpO2 had no obvious difference among three groups （P〉0.05）. MAT in the group IU were lower than that in the group I and Ⅱ （P〈0.05）. HR in the group Ⅲ was higher than that in the group I and Ⅱ （P〈0.05）. The VAS scores of postoperative pain in the group Ⅱ and Ⅲ were lower than those in the group I （P〈0.05）.The BCS scores in the group Ⅱ were higher than those in the group I and m （P〈O.05）. The onset time and highest segment time of sensory nerve block in the group I and Ⅱ were significantly shorter than those in the group m （P〈O.05）. The motor nerve block state in the group Ⅱ and Ⅲ was significantly effective than that in the group I before cutting skin （P〈0.05）. The satisfaction of physicians in the group Ⅱ and m was better than that in the group I （P〈0.05）. Conclusion The 2% lidocaine hydrochloride 7.5 mL combined 1% ropivacaine hydrochloride 7.5 mL in epidural anesthesia is more effective than other combinations.