罗哌卡因在腰硬联合阻滞中的应用研究(1)
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[摘要] 目的 探讨罗哌卡因在腰硬联合阻滞中应用的安全性及效果。 方法 360例下腹部及下肢手术患者随机分为硬膜外麻醉组及腰硬联合麻醉组，分别采用罗哌卡因麻醉，比较两组患者术中血流动力学指标、麻醉效果和不良反应。 结果 两组患者术中收缩压、舒张压、心率无统计学意义，腰硬联合麻醉组患者麻醉起效时间及麻醉持续时间均优于硬膜外麻醉组，腰硬联合麻醉组术后不良反应发生率与硬膜外组比较无统计学意义。 结论 罗哌卡因硬膜外-腰麻联合阻滞麻醉具有较高的安全性，麻醉效果较好，适宜于下腹部及下肢手术麻醉。
[关键词] 罗哌卡因；硬膜外麻醉；腰硬联合麻醉
[中图分类号] R714.3 [文献标识码] B [文章编号] 1673-9701(2012)04-0117-03
Applications study of ropivacaine on epidural anesthesia combined lumbar anesthesia
LENG Fenrong YANG Changmei ZHU Liuhui
Department of Anesthesiology, Traditional Chinese Medical Hospital of Jiande City in Zhejiang Province, Jiangde 311600, China
[Abstract] Objective To investigate the effect and safety of ropivacaine on epidural anesthesia combined lumbar anesthesia. Methods All of 360 cases patients with hypogastrium and lower limb operations were randomly divided epidural anesthesia groups (EA) and epidural anesthesia combined lumbar anesthesia (ECLA), and ropivacaine were taken in two groups, parameter of hemodynamics, anaesthetic effect and rate of untoward reaction were contrasted between EA and ECLA. Results The heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) was identical between two groups before anesthesia, during operations and postoprations, time of taking effecy and time of duration in anesthesia was prevalent in ECLA than in EA, rate of untoward reaction after operations was identical between two groups. Conclusion Ropivacaine has higher safety and good effect in epidural anesthesia combined lumbar anesthesia, was suitable for applications in hypogastrium and lower limb operations.
[Key words] Ropivacaine；Epidural anesthesia；Epidural anesthesia combined lumbar anesthesia
罗哌卡因是一种新型长效酰胺类局麻药，具有毒性小和感觉运动分离的特性[1]，已广泛应用于硬膜外阻滞，并且具有良好的麻醉效果。近年来硬腰联合麻醉阻滞技术在临床应用逐渐广泛，腰硬联合阻滞多采用作用时间短的短效麻醉剂，以增加麻醉安全。近年来我院采用罗哌卡因进行腰硬联合阻滞，取得了良好的麻醉效果，现报道如下。
1 资料与方法
1.1 一般资料
选择我院2007年1月～2010年12月间下肢、下腹及肛门直肠手术患者360例，年龄16～91岁，体重31～94 kg，身高143～185 cm。ASA Ⅰ级179例、Ⅱ级104例、Ⅲ级60例、Ⅳ级17例，其中Ⅳ级仅限于下肢手术；下腹部手术126例，肛周手术102例，下肢手术132例。患者入选后随机分为硬膜外麻醉组及硬腰联合麻醉组；两组患者的性别、年龄、ASA分级及手术方式经统计学分析无统计学意义，具有可比性。
1.2 麻醉方法
患者术前常规麻醉前准备，术前30 min根据患者情况肌注咪达唑仓针2.0~4.0 mg(江苏恩华药业)、长托宁针0 ......
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