0.5%罗哌卡因和0.5%布比卡因在高龄患者腰麻-硬膜外联合麻醉中的比较

目的比较0.5%罗哌卡因和0.5%布比卡因腰麻-硬膜外联合麻醉在高龄患者经尿道前列腺电切术中的临床效果及安全性。方法60例择期行经尿道前列腺等离子汽化电切术高龄患者,随机分为两组,Ⅰ组(n=30),用0.5%罗哌卡因2 ml;Ⅱ组(n=30),用0.5%布比卡因2 ml。观察痛觉减退平面、痛觉消失平面、感觉阻滞起效时间和镇痛持续时间、运动阻滞起效时间、达最大运动阻滞时间、最大阻滞节段、运动阻滞的持续时间、麻醉效果评定、低血压和心动过缓例数。结果Ⅰ组感觉阻滞起效时间明显慢于Ⅱ组,痛觉阻滞持续时间明显小于Ⅱ组(P<0.01);两组最大感觉阻滞平面无显著差异(P>0.05);Ⅰ组运动阻滞起效时间明显慢于Ⅱ组,运动阻滞维持时间明显短于Ⅱ组(P<0.01);两组麻醉效果评定无统计学差异(P>0.05)。Ⅰ组的低血压和心动过缓例数明显小于Ⅱ组(P<0.05)。结论罗哌卡因较之布比卡因用于腰麻-硬膜外联合麻醉在高龄患者经尿道前列腺电切术更加安全有效,更有利于患者术后早期活动。

Comparison between Ropivacaine and Bupivacaine in Clinical Combined Spinal-epidural Anesthesia on Senile Patients

Objective To compare the clinical effects of combined spinal-epidural anesthesia with ropivacaine and bupivacaine on senile patients undergoing plasmakinetic(PK-) transurethral prostatectomy and their safety.Methods We choose 60 senile patients to perform PK-transurethral prostatectomy.They were divided into Group A(n=30) and Group B(n=30) at random,which were anesthetized respectively with 0.5% of Ropivacaine and Bupivacaine(2ml) by the same way.Some indexes were observed,such as the hypalgesic or analgesic plane,the time of aesthema-blocking and motor-blocking coming into effect,maintaining time of analgesia and motor-blocking,the maximal motor-blocking time,the maximal blocking segment,the evaluation of the anesthetic effects,the number of patients suffering from hypotension and bradycardia. Results Group A possessed a later time of aesthema-and motorblocking coming into effect and shorter maintaining time of analgesia and motor-blocking(P<0.01).There was no significant difference in the maximal sensatory blocking plane between the two groups(P>0.05).There was no statistical difference in the evaluation of anesthetic effect(P>0.05).Moreover,There were less patients who suffered from hypotension and bradycardia in Group A than in Group B(P<0.05).Conclusion In the total evaluation of clinical effect on senile patients undergoing PK-transurethral prostatectomy,ropivacaine is the safer and more effective candidate than Bupivacaine in combined spinal-epidural anesthesia,and benefits the patients from early movement after operation.