国人不同剂量布比卡因复合芬太尼腰麻在肛肠疾病患者日间手术中的效果比较

目的 探索最佳适合国人的肛肠手术患者日间手术的腰麻用药方案.方法 ASA Ⅰ～Ⅱ级肛肠手术患者80例,随机分成两组,按照腰麻用药方案不同分别为0.75％布比卡因0.3 ml+芬太尼15 μg+50％葡萄糖0.05 ml(A组)和0.75％布比卡因0.5 ml+芬太尼15 μg+50％葡萄糖0.05 ml(B组),记录两组患者围术期血流动力学变化和麻醉后患者感觉,运动阻滞起效和持续时间,肛门松弛度,手术后恶心、呕吐、尿潴留、瘙痒等不良反应,外科医师和患者满意率.结果 B组术前与术后血流动力学明显变化,A组无明显变化.B组感觉阻滞起效时间短于A组,持续时间明显较A组长.运动阻滞强度B组大于A组,肛门松弛度A组差于B组.患者满意度和外科医师满意度B组较A组高.手术后恶心、呕吐、尿潴留、瘙痒发生率无明显差异.B组低血压发生率较A组高.结论 B组0.75％布比卡因0.5 ml+芬太尼15 μg是国人腰麻进行肛肠日间手术较为适合的麻醉用药剂量.

Effective comparison of different doses of bupivacaine with fentanyl in spinal anesthesia for day-surgery of anorectal patients in Chinese

Objective To explore the optimum doses of bupivacaine with fentanyl in spinal anesthesia for day surgery of anorectal patients in Chinese.Methods 80 patients undergoing anorectal surgery(ASA gradeⅠ-Ⅱ) were randomly divided into the group A and B.Spinal anesthesia was performed with 0.75% bupivacine 0.3 ml,fentanyl 15 μg and 50% glucose 0.05 ml for the group A and 0.75% bupivacine 0.5 ml,fentanyl 15 μg and 50% glucose 0.05 ml for B group respectively.The vital signs of BP,HR and SpO2 were monitored in both groups.Onset and duration of sensation and movement block were recorded.The patient satisfaction and surgeon satisfaction were recorded.The adverse reactions such as anal looseness,hypotension,urine retention,nausea,vomiting and pruritus were recorded too.Results The hemodynamic changes in the group B were obvious before and after anesthesia,which in the group A was unobvious.The onset time of sensory block in the group B was significantly shorter than that in the group A,and the duration of sensory block in the group B was significantly longer than that in the group A.The movement block in the group B was significantly more than that in the group A.Anal looseness in the group A was significantly less than that in the group B.The patient satisfaction and surgeon satisfaction in the group B were significantly higher than those in the group A.The rate of pruritus,nausea,vomiting,and urine retention had no significant differences between the two groups.The rate of hypotension in the group B was significantly higher than that in the group A group.Conclusion 0.75% bupivacine 0.5 ml,fentanyl 15 μg and 50% glucose 0.05 ml in spinal anesthesia are the suitable doses for the Chinese patients undergoing day-surgery of anorectal operation.