不同浓度罗哌卡因在腰椎手术硬膜外麻醉中效应的比较

目的选择罗哌卡因在腰椎手术中硬膜外阻滞的适当浓度。方法随机选择45例择期行腰椎手术患者，比较不同浓度0．375％、0．5％和0．75％的罗哌卡因在硬膜外阻滞的镇痛效果、阻滞踝关节屈曲的情况及并发症的发生率。结果不同浓度罗哌卡因在T6节段感觉阻滞的起效时间差异无显著性（P〉0．05），0．375％组在T6节段感觉阻滞的消褪时间较其他组显著缩短（P〈0．05）。在镇痛质量方面，0．5％组与0．75％组相近，0．375％组在剥离椎间盘时与其他两组差异显著（P〈0．05）。在运动阻滞方面，0．75％组运动神经阻滞较完全，多数患者不能屈曲踝关节，而其他两组基本不阻滞踝关节，0．75％组与其他两组相比较差异非常显著（P〈0．01）。0．75％组出现呼吸抑制等并发症最多，硬膜外0．5％罗哌卡因的镇痛效果好，基本不阻滞踝关节的屈曲，发生呼吸困难等并发症少见。结论硬膜外0．5％罗哌卡因为腰椎手术较为适当的浓度选择。

The Effect of Ropivacaine with Different Conconcentration in Operative Therapy of Lumbar Disc Protrusion

Objective To explore the best conconcentration of ropivacaine in operative therapy of lumbar disc protrusion（LDP）. Methods Forty- seven adult ASA I- Ⅲ patients scheduled for LDP surgery were randomly divided into three groups by using different conconcentration of ropivacaine （ 0.75 % group, 0.5 % group, 0. 375 % group）, and evalued the effect of anesthesia, the ankle articulation flex block and the rate of complications. Resuits There is no difference among the three groups in the time of sensory block at T6 （P 〉 0.05 ）, and it is significantly short in the extinctive time of sensory block in 0. 375 % group （ P 〈 0.05 ） ; most of patients in 0.75 % group could not bend their ankles, which had significant difference between this group and the others. The better effect of anesthesia and less complications were found in 0.5 % group, and few ankle articulation flex block and respiratory depression had happened. Conclusions The best conconcentration of ropivacaine in operative therapy of LDP was 0.5 percent.