Comparison of clinical effects of small-dose isobaric solution for lumbar anesthesia at different blocking planes in anorectal surgery patients
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摘要:目的 比较小剂量等比重腰麻在控制不同阻滞平面用于肛肠手术的临床效果。方法 将120例拟行肛肠手术的患者随机分为C组(常规腰麻, n=60)和L组(低平面腰麻, n=60)。C组患者左侧卧位下向头部方向正常速度推注5 mg 0.375%等比重布比卡因, 麻醉平面在T12水平; L组采用相同体位下小剂量布比卡因向尾部方向缓慢注药，控制麻醉平面于L5水平。对比2组镇痛持续时间、自主排尿恢复时间、下肢运动阻滞情况、尿潴留等不良事件发生情况。结果 2组均顺利完成手术。与C组比较, L组患者镇痛持续时间较长，对下肢运动阻滞影响更小(P < 0.05)。2组不良反应差异无统计学意义(P>0.05)。结论 小剂量等比重腰麻在控制较低麻醉平面患者有较好的效果，能够保持下肢运动功能，提高患者舒适度。Abstract:Objective To observe the clinical effects of lumbar anesthesia with small-dose isobaric solution in controlling different blocking planes for anorectal surgery.Methods A total of 120 patients treated by anorectal surgeries were randomly divided into group C (conventional lumbar anesthesia, n=60) and group L (low-plan lumbar anesthesia, n=60). At left lateral position, the patients in group C were injected with bupivacaine at an equal proportion of 5 mg 0.375% and normal speed to the head, and the anesthetic plane was at the level of T12. Group L was slowly injected by bupivacaine to the tail direction with the same lower dose at the same position, with anesthetic plane of L5. The duration of analgesia, recovery time of spontaneous urination, block condition of lower limb movement and incidence of complications such as urinary retention were compared between the two groups.Results The operations were successfully completed in both groups. Compared with group C, the duration of analgesia in group L was longer and motor block for lower limb was less (P < 0.05). There were no significant differences in incidence of complications in two groups (P>0.05).Conclusion Small-dose isobaric solution in controlling lower blocking planes for anorectal surgery has better efficacy, which can maintain lower limb movement function, and improve patients′comfort degree.
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Keywords:
- bupivacaine /
- lumbar anesthesia /
- anorectal surgery /
- urinary retention /
- spontaneous urination
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表 1 2组患者不同时点HR、SBP、DBP比较(x±s)
指标 组别 n T0 T1 T2 T3 HR/(次/min) C组 60 78.6±6.4 76.6±7.5 74.4±5.8 75.6±7.6 L组 60 76.4±8.3 75.3±5.4 74.6±7.2 73.5±6.7 SBP/mmHg C组 60 128.6±12.2 114.6±11.5# 116.3±9.7# 126.6±10.4 L组 60 126.5±11.8 120.8±12.2* 122.7±10.3* 124.7±9.8 DBP/mmHg C组 60 68.2±10.2 61.5±11.4# 61.8±9.8# 66.8±10.2 L组 60 66.6±9.5 65.7±10.7* 65.8±10.5* 65.2±9.4 HR: 心率; SBP: 收缩压; DBP: 舒张压。与T0比较, #P < 0.05; 与C组比较, *P < 0.05。 
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表 2 2组患者镇痛时间、自主排尿时间、Bromage评分等级情况比较(x±s)[n(%)]
组别 n 镇痛时间/min 自主排尿恢复时间/min Bromage评分等级 0级 1级 2级 3级 C组 60 228.5±23.8 264.6±28.8 0 12(20.0) 21(35.0) 27(45.0) L组 60 243.2±28.4* 255.7±32.6 54(90.0)* 6(10.0)* 0* 0* 与C组比较, *P < 0.05。
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[1] 段吉安, 胡年春, 余裕钦, 等. 不同浓度小剂量利多卡因腰硬联合麻醉在老年肛肠疾病患者非PPH中的临床效果观察[J]. 重庆医学, 2017, 46(33): 4625-4627. doi: 10.3969/j.issn.1671-8348.2017.33.006 [2] 孙文琴, 刘明姬, 莫利求, 等. 小剂量布比卡因腰麻在吻合器痔环切术中的应用效果[J]. 临床麻醉学杂志, 临床麻醉学杂志2013, 29(8): 758-760. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201308014.htm [3] 李国艳, 周维品, 李佳. 小剂量等比重布比卡因蛛网膜下腔麻醉在日间肛肠手术中的应用[J]. 实用医院临床杂志2014, 4 (11): 118-120. https://www.cnki.com.cn/Article/CJFDTOTAL-YYLC201404036.htm [4] Gurbet A, Turker G, Girgin N K, et al. Combination of ultra-low dose bupivacaine and fentanyl for spinal anaesthesia in out-patient anorectal surgery[J]. J Int Med Res, 2008, 36(5): 964-970. doi: 10.1177/147323000803600512
[5] 吴浩云. 超小剂量重比重布比卡因蛛网膜下腔阻滞用于肛肠手术的临床观察[J]. 吉林大学, 2018, 39(9): 1669-1671. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYX201809029.htm [6] 姜春南, 吴卫东, 张辉, 等. 不同脊麻针型对剖宫产术后头痛的影响[J]. 江苏医药, 2013, 39(16): 1972-1973. https://www.cnki.com.cn/Article/CJFDTOTAL-YIYA201316047.htm [7] 宋海明, 马靖华. 等比重布比卡因腰麻复合腰丛麻醉对老年髋关节置换术中血流动力学及术后并发症影响[J]. 中国临床研究, 2017, 30(3): 371-373. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK201703026.htm [8] Ganem E M, Vianna P T G, Marques M, et al. Response to comments on effect of subarachnoid hyperbaric bupivacaine in dogs[J]. Reg Anesth, 1997, 22(2): 198-199. http://www.sciencedirect.com/science/article/pii/S109873390680043X
[9] 李胜锋, 王安, 奎周颖. 等比重布比卡因脊麻用于剖宫产手术的临床观察[J]. 临床麻醉学杂志, 2012, 28(11): 1127-1128. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201211039.htm [10] 曾鸿, 郑成辉, 王军, 等. 腰麻剖宫产术中产妇凝血功能的变化[J]. 临床麻醉学杂志, 2016, 32(8): 809-810. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201608029.htm [11] 许景贤, 仲吉梅. 中西医结合治疗术后尿潴留[J]. 赤峰学院学报: 自然科学版, 2012, 28(12): 53-54. doi: 10.3969/j.issn.1673-260X.2012.12.023 [12] 张淑萍. 不同剂量布比卡因腰麻后对运动、排尿功能影响的临床观察[J]. 新疆医学, 2015, 45(2): 191-192. https://www.cnki.com.cn/Article/CJFDTOTAL-XJYI201502013.htm
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