小剂量芬太尼-罗哌卡因鞍麻在肛肠手术中的应用

目的 观察小剂量芬太尼-罗哌卡因鞍麻在肛肠手术中的临床应用.方法 24例肛肠手术患者随机分为小剂量芬太尼-罗哌卡因鞍麻组（观察组）和罗哌卡因局部麻醉组（对照组）,观察麻醉起效时间、镇痛持续时间、血流动力学、应激指标等,同时用改良的Bromage分级评估下肢运动神经阻滞程度,及指诊肛门括约肌阻滞程度.结果 2组感觉阻滞起效时间、运动阻滞起效时间、术后运动阻滞程度、术中镇痛效果均无统计学差义;观察组术中血压（BR）、心率（HR）及心率与收缩压的乘积（RPP）低于对照组（P＜0.01）;观察组术中肌松情况及镇痛效果优于对照组（P＜0.05或P＜0.01）;2组患者血浆皮质醇、血糖和C反应蛋白浓度术后2 h时均明显高于麻醉前（P＜0.01）,而观察组又低于对照组（P＜0.01）.结论 小剂量芬太尼-罗哌卡因鞍麻可减弱患者的应激反应,具有血流动力学影响小、术中肌松满意、术后镇痛时间长的特点,是适用于肛肠手术的一种简单、安全、有效的麻醉方法.

The clinical application of saddle block anesthesia with low-dose fentanyl-ropivacaine in anorectal surgery

Objective To investigation the effect of the clinical application of low - dose fentanyl ropivacaine saddle block anesthesia in anorectal surgery. Methods Twenty - four patients undergoing anorectal surgery were randomized into saddle block anesthesia with low - dose fentanyl ropivacaiue group （ observation group） and local anesthesia with ropivacaine group （control group）. The anesthesia onset time, analgesic duration, hemodynamics, and emergency index, etc. were observed. Meanwhile, the modified Bromage scale was employed to assess the blockage degrees of the lower limb motor neurons and anal sphincter tonieity by digital rectal examination. Results There were no significant statistical differences in the block onset time points, motor neuron block onset time points, postoperative motion block degrees and intraoperative analgesic effects; the intraoperative blood pressure （BP）, heart rate （HR） and heart rate -systolic pressure product （RPP） were lower in the observation group than those in the control group （ P 〈 0.01 ） ; the level of intraoperative sphincter relaxation and analgesic effects in the observation group were superior to that in the control group （ P 〈 0.05 or P 〈 0.01 ） ; the levels of plasma cortisol （Cor） and blood sugar as well as the C - reactive protein （CRP） concentration at T1 were significantly higher than those at To （ P 〈 0.01 ） in both groups, while the parameters in the observation group were lower in the observation group than in the control group （ P 〈 0.01 ）. Conclusion Low - dose fentanyl - ropivacaine saddle block anesthesia can reduce the stress response in patients, with the characteristics of lower effect on hemodynamics, satisfactory intraoperative sphincter relaxation and prolonged postoperative analgesic duration, which is qualifies it to be a simple, safe and effective anesthetic method of anoretal surgery.