布比卡因复合芬太尼腰麻在急诊下肢手术中的应用

目的:探讨芬太尼腰麻对下肢手术麻醉的临床效应。方法:选择ASA分级I～II行急诊下肢手术病人40例,随机分为两组,每组20例,实验组(F组)使用0.75﹪布比卡因7.5mg(1mL)+芬太尼25μg(0.5mL),对照组(B)腰麻使用0.75﹪布比卡因11.5mg(1.5mL),腰麻药中均加入10﹪葡萄糖1mL,总容量为2.5mL,选择L3～4间隙穿刺,术中观察记录病人血压(SBP,DBP,MAP),HR,麻醉效果,运动阻滞情况及不良反应。结果:B组血压下降比F组更加显著,B组有5例需加麻黄素处理,F组血压有轻微下降,但均在代偿范围之内,不需加麻黄素处理(P<0.05);B组Bromage评分为3～4分,F组得分主要为2～3分;两组术后恶心,呕吐,皮肤搔痒及尿潴留等无显著性差异。结论:小剂量芬太尼用于腰麻对急诊骨科下肢手术循环影响小,麻醉效果确切,术后患者能及早运动,不良反应少,值得推广。

Bupivacaine-fentanyl Spinal Anesthesia on the Emergency Operation of Lower Extremities

Objective To study the clinical effects of fentanyl spinal anesthesia on the emergency operation of lower extremities.Methods 40 ASA Ⅰ~Ⅱ patients who need emergency operation of lower extremities were randomLy divided into two groups: Group B received a spinal anesthesia with 0.75% bupivacaine 11.5mg(1.5mL),the other group(group F) received a spinal anesthesia with 0.75% bupivacaine 7.5mg(1mL) and fentanyl 25μg(0.5mL).Intraoperative observation of patients blood pressure(SBP,DBP,MAP),HR,anesthesia effect,degree of motor block and side effects were recorded.Results Blood pressure in group B decreased significantly more than the group F,5 cases of Group B needed a deal with ephedrine.There was a slight drop in blood pressure of Group F,but was within the scope of compensation,no deal plus ephedrine(P<0.05).Group B was scored 3～4 points by method Bromage.The majority of Group F scored 2 ～3 points.There was no significant difference of nausea,vomiting,skin itching and urinary retention between the two groups.Conclusion Low-dose fentanyl spinal anesthesia for lower extremity emergency surgery has a small impact on blood cycle,precise anesthetic effect,fewer adverse reactions.Patients can get an early movements.It is worth promoting.