腰段硬膜外腔布比卡因镇痛后反射改变与下肢运动障碍

目的探讨腰段硬膜外布比卡因止痛后脊神经反射与肌肉运动阻滞的相关差异。方法男性成年患者５０例,随机分为Ａ、Ｂ、Ｃ、Ｄ、Ｅ ５组,每组 １０例,分别在术后双盲法硬膜外注入 ０． １％０． １５％、０． ２％、０． ２５％布比卡因及生理盐水 １０ ｍｌ,注药前后记录目测类比评分（ＶＡＳ）。结果ＶＡＳ评分,Ａ、Ｂ、Ｃ、Ｄ与Ｅ组Ｐ＜０．０１;反射变化,Ａ与Ｅ组Ｐ＞０．０５,Ｂ、Ｃ、Ｄ与Ｅ组Ｐ＜０．０５或０．０１;关节运动变化：Ａ与Ｅ组Ｐ＞０．０５,Ｂ、Ｃ、Ｄ与Ｅ组Ｐ＜０．０１,各组反射与运动变化率相近,但其中反射完全消失率与运动完全消失率之比为５：１。结论布比卡因腰段硬膜外止痛出现运动神经阻滞时,脊神经反射比肌肉运动变化更为敏感,可作为临床示警性指标。

Spinal reflex abatement compare with motor block during the low epidural anesthesia

Objective To investigate a difference of spinal reflex and muscular motor block during low epidural analgesia. Method adults50 patients were randomly divided into five groups(n = 10) with double-blinded study, and were injected 8 ~ 10 ml of "analgesic"which were 0. l%, 0. 15%, 0. 20%, 0. 25% bupivacaine and physiologic saline. To observe contents before the injection and after the injection: visual analogue scale (VAS); refelex activities(low abdominal reflex, cremasteric reflex, knee jerk reflex, Achilles tendon reflex) and muscular motions of the hip joint, knee joint and ankle joint at normal leg. Result in respect of VAS, groups A.B.C and D compared with group E, each P < 0. 01. The reflexes change: group A was compared with group D P > 0. 05, group B. C and D with group E P < 0. 05 or 0. 01; Motor variations of foe joints: group A was compared group E P > 0. 05, rest groups with E each P < 0. 01; variant percentages of the reflexes and the motors are similar the percentage of reflexes disappear was five times the percentage of motor disappar. Conclusion if motor nerve was blocked, the reflexes weaken is more sensitive so that it is may be a warning of the motor blocking during epidural analgesia.