老年人日间肛肠手术中等比重罗哌卡因单次腰麻合理剂量的应用及其安全性评价

目的：探讨老年人日间肛肠手术中等比重罗哌卡因头高足低体位单次腰麻的合理剂量，并对其安全性进行评价，为老年人日间肛肠手术的临床麻醉提供依据。方法：老年肛肠病手术患者120例随机分为罗哌卡因0.8、1.0、1.3和1.5 mL 组，每组30例,各组患者均给予1%罗哌卡因与脑脊液分次混合液，经蛛网膜下腔分别注入0.8、1.0、1.3和1.5mL，观
察患者麻醉效果、生命体征、麻醉平面固定时间、术后麻醉完全恢复时间、不良反应等。结果：随着罗哌卡因剂量增加，各组患者生命体征变化和感觉平面固定时间比较差异均无统计学意义 (P>0.05)；最高阻滞平面≤T5-8发生率变化比较，罗哌卡因1.3和1.5 mL组均大于罗哌卡因0.8和1.0 mL组(P<0.05)；罗哌卡因1.5 mL组感觉阻滞维持时间最
长，与其他3组比较差异有统计学意义(P<0.05)；术中肌松程度比较，罗哌卡因0.8 mL组欠佳，而罗哌卡因1.0、1.3、1.5 mL组均能满足手术要求，与罗哌卡因0.8 mL比较差异有统计学意义(P<0.05)；罗哌卡因0.8 mL组术中牵拉腹痛
发生率高，与其他3组比较差异有统计学意义(P<0.05)；罗哌卡因1.3和1.5 mL组运动神经阻滞完全消退时间最长，与罗哌卡因0.8 mL组比较差异有统计学意义(P<0.05)，但罗哌卡因1.5 mL组患者需术后导尿的发生率最高，与其他3组比较差异有统计学意义(P<0.05)。结论：老年人日间肛肠手术应用1%罗哌卡因分次脑脊液稀释实施头高足底体位下等比重单次腰麻剂量以1.0～1.3 mL为宜，患者生命体征平稳，不良反应少。

Application of reasonable dosage of single spinal anesthesia with isobaric ropivacaine on block in elder patients underwent daytime anorectal surgery and its safety evaluation

Objective To observe the reasonable dosage of single spinal anesthesia with isobaric ropivacaine on block in elder patients undergoing daytime anorectal operation and its safety evoluation,and to provide the basis on clinical anesthesia for the elderly daytime anorectal surgery.Methods 120 elder patients underwent selective anorectal operation were randomly divided into ropivacaine 0.8,1.0,1.3 and 1.5 mL groups,and there were 30 cases in each group.0.8,1.0,1.3,and 1.5 mL 1% ropivacaine mixed with cerebrospinal fluid were injected into the patients in each group through subarachnoid cavity.The effect of anesthesia,the vital signs,the time of anesthesia level fixation,the time of postoperative anesthesia complete recovery,and the adverse reaction were recorded.Results With the increasing of the doses of ropivacaine,the vital signs changes and the sense level fixation time had no statistical differences between various groups(P>0.05).The incidence of maximum block level ≤T5-8 in ropivacaine 1.3 and 1.5 mL groups were higher than that in 0.8 and 1.0 mL groups(P<0.05).The sense block maintenance time in ropivacaine 1.5 mL group was longer than that in the other groups(P<0.05).The intraoperative muscle relaxation degrees in ropivacaine 1.0,1.3,and 1.5 mL groups were all satisfied compared with ropivacaine 0.8 mL group(P<0.05).The incidence of intraoperative force abdominal pain in ropivacaine 0.8 mL group was the highest(P<0.05).The complete recovery time of motor nerve block in ropivacaine 1.3 and 1.5 mL groups was the longest,there was significant difference compared with ropivacaine 0.8 mL group(P<0.05).But the patients in ropivacaine 1.5 mL group needed mostly urethral catheterization after operation(P<0.05).Conclusion 1.0-1.3 mL 1% ropivacaine are suitable for single spinal anesthesia in elder patients underwent daytime anorectal operation,and the patients have stable vital signs and little adverse reaction under these conditions.