轻比重单侧腰麻在下肢手术中的应用研究

目的：探讨轻比重单侧腰麻在下肢手术中应用的临床效果。方法：收集并选择于广西壮族自治区北海市中医院拟行下肢手术且ASAⅡ～Ⅲ级患者90例，将其随机分为A、B、C三组，每组各30例，于L2-3或L3-4间隙分别向蛛网膜下腔注射0．167％轻比重布比卡因溶液3m1（A组）、0．25％轻比重布比卡因溶液2ml（B组）、0．375％轻比重布比卡因溶液2ml（C组），观察并记录患者给药前5min，给药后5、10min的收缩压（SBP）、心率（HR）、血氧饱和度（SpO：）、达最高阻滞平面时间、感觉阻滞起效及持续时间、感觉阻滞范围、下肢运动阻滞起效及持续时间、Bromage评分、视觉模拟评分（VAS）、术中与术后不良反应及术后并发症等情况。结果：三种不同浓度轻比重布比卡因均可产生单侧阻滞的麻醉效果，效果评定A组优25例，良5例；B组优24例，良6例；C组优26例，良4例，三组优良率均为100％；A、B组低血压发生率分别为20．0％、13．3％，与C组（16．7％）比较差异有统计学意义（P〈0．05）；A、B组感觉恢复时间及运动恢复时间[A组：（132．5±25．4）、（110．6±23．6）,in；B组：（135．5±26．9）、（115．7±25．3）min]明显短于C组[（178．3±28．3）、（153．4±31．2）min]，差异均有统计学意义（P〈0．05），提示麻醉有效镇痛时问C组明显高于A、B组。结论：轻比重单侧腰麻应用于下肢手术具有麻醉起效迅速、阻滞效果理想、血流动力学稳定且并发症少等优点，具有很高的临床应用价值。

Application study of light specific gravity unilateral lumbar anesthesia in lower limb operations

Objective： To evaluate the clinical effect of light specific gravity solution application in unilateral lumbar anesthesia of lower limb operations. Methods： 90 cases of ASA II - III grade patients who were scheduled for lower limb surgery in traditional Chinese medicine hospital of Beihai city were selected and randomly divided into groups A, B, C, each of 30 cases. Spinal anesthesia was performed in L2-3 or L3-4 of all patients. 3 ml 0.167% hypobaric Bupivacaine was injected in group A, 2 ml 0.25% hypobaric Bupivacaine was injected in group B and 2 ml 0.375% hypobaric Bupivacaine was injected in group C. SBP, FIR, Sp02, reaching the highest block level time, sensory block onset and duration time, sensory block extent, lower limb motion block onset and duration time, Bromage score, visual analogue scale （VAS）, intraoperative and postoperative adverse events and complications were observed and recorded 5 rain before anesthesia and 5 and 10 min after anesthesia. Results： Unilateral block anesthesia was produced by three different concentrations of hypo-baric Bupivacaine. The effects assessment of group A had 25 cases of excellent, 5 cases of good; 24 cases of excellent and 6 cases of good in group B; 26 cases of excellent and d cases of good in group C. The excellent rates of the three groups were 100%. The hypotension incidence of group A and B （20.0%, 13.3%） were statistically significant differences with group C （16.7%） （P〈0.05）. The feeling recovery time and sports recovery time of group A and B [group A： （132.5±25.4）, （110.6± 23.6） min; group B： （135.5±26.9）, （115.7±25.3） rain] were statistically significant shorter than group C [（178.3±28.3）, （153.4±31.2） nlin] （P〈0.05）, so the effective time of analgesia and anesthesia of group C was significantly higher than that of group A and group B. Conclusion： Application of light specific gravity solution in unilateral lumbar anesthesia of lower limb operations has advantages of rapid onset, satisfaction of block results, steady of hemodynamic effects and few complications. It has high value of clinical application.