目的 探讨腰麻和硬脊膜外联合麻醉中不同脑脊液流速对麻醉效果的影响。 方法 选择医院 2017-01至2018-01膝关节交叉韧带损伤需实施关节镜下韧带重建术的200例患者,分为A、B组,每组100例。A组脑脊液流速5 s以下,B组脑脊液流速10 s以上,A、B两组均选择腰麻和硬脊膜外联合麻醉, 蛛网膜下腔均给予0.5%罗哌卡因3 ml,且推注速度均为0.1 ml/s,观察并记录两组患者麻醉效果及不良反应的发生情况。 结果 A、B两组T8阻滞出现时间分别为(9.16±0.41)min和(11.97±0.44)min;镇痛最高平面出现时间为(11.12±0.23)min和(15.24±0.22)min,A组均早于B组,差异有统计学意义(P<0.05);两组运动阻滞平面Bromage 评分比较差异无统计学意义; A组患者止血带效果为优者占99%,仅1例效果为良,明显好于B组(优87%,良12%),差异有统计学意义(P<0.05)。 结论 脑脊液流速对麻醉平面和麻醉效果产生明显影响,脑脊液流速在5 s以下,以速度为0.1ml/s的0.5%罗哌卡因推注可获得满意的麻醉效果。
Abstract
Objective To explore the influence of different cerebrospinal fluid flow rates on the effectiveness of combined spinal-epidural anesthesia.Methods Two hundred patients undergoing anterior cruciate ligaments (ACL) of knee joint reconstruction with arthroscopy were selected and randomly divided into two groups: group A in which the cerebrospinal fluid flow rate of patients was less than 5 s (n=100) and group B in which the flow rate was above 10 s (n=100). Both groups received combined spinal-epidural anesthesia with 0.5% ropivacain 3 ml, which was diluted with 0.9% normal saline 1 ml.The injection speed was 0.1 ml/s in both groups. Anesthesia was maintained with epidural administration with 2% lidocaine if necessary during operation.Results In group A, the onset of pain block to T8 was earlier than in group B, which was(9.16±0.41) vs (11.97±0.44)min (P<0.05), while the onset time of the highest analgesia plane was(11.12±0.23)vs(15.24±0.22)min (P<0.05).There was no statistically significant difference between the two groups according to the Bromage score for motor block. The effect of tourniquets was excellent in 99% of the cases in group A, which was better than in group B (87%) (P<0.05).Conclusions The cerebrospinal fluid flow rate has much influence on the anesthesia plane and anesthetic effect. A cerebrospinal fluid velocity below 5 s and an injection speed of 0.1ml/s with 0.5% ropivacaine can yield satisfactory anesthetic effect. Anesthesiologists should adjust the drug injection rate according to the cerebrospinal fluid velocity in order to achieve the optimal anesthetic effect.
关键词
膝关节交叉韧带 /
腰麻和硬脊膜外联合麻醉 /
0.5%罗哌卡因 /
脑脊液流速 /
麻醉效果 /
不良反应
Key words
anterior cruciate ligament /
combined spinal epidural anesthesia /
0.5% ropivacain /
flow rate of cerebrospinal fluid /
anesthetic effect /
adverse reactions
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 吴鲜艳.小剂量等比重腰麻-硬膜外联合麻醉对老年下肢骨折手术的应用价值[J].医学理论与实践,2017,30(3):389-390.
[2] 杨文科,翁建东,周东贤.腰-硬联合麻醉不同注药速度对麻醉平面的影响[J].临床麻醉学杂志,2003,19(1):49.
[3] 刘小勇,刘文勇.0.5%罗哌卡因腰硬联合麻醉时不同注药速度的麻醉效果观察[J].现代诊断与治疗,2017,28(8):1404-1405.
[4] Kim B G,Kang H.The effect of preemptive periminal ropivacaine and ropivacaine with dexmedetomidine on pain after hemorrhoidectomy: a prospective,randomized,double- blind,placebo-controlled study[J]. Indian J Surg,2014,7(1):49-55.
[5] 王月珍. 腰-硬联合麻醉在剖宫产手术中的应用体会[J].中国社区医师:医学专业,2012, 14(16):170.
[6] 欧起钊. 腰硬联合麻醉不同注药方向在妇科手术中的临床观察[J].中外医学研究,2012,10(36):28-29.
[7] Kiadaliri A A,Englund M,Lohmander L S,et al. No economic benefit of early knee reconstruction over optional delayed recon-struction for ACL tears: registry enriched randomised controlled tri-al data[J].Br J Sports Med,2016,50(9):558-563.
[8] 高珞珞,王 洁.膝关节镜下交叉韧带重建术的围术期护理体会 [J].护士进修杂志,2016, 31(20):1866-1868.
[9] 王 薇,贾东林. 轻比重腰麻在临床麻醉中的应用进展[J]. 山东医药,2011,51(24):113-114.
[10] 郭艳辉,王俊科,许国忠,等.罗哌卡因用于蛛网膜下腔阻滞的实验研究[J].中华麻醉学杂志,2002, 22(1):42-45.
[11] 王心田,马武华,李荣胜,等.轻比重罗哌卡因腰麻用于老年患者人工关节置换术的量-效关系[J].临床麻醉学杂志,2008,24(1):23-25.
[12] 蔡恒宇,吴秀英 .不同浓度舒芬太尼复合罗哌卡因用于分娩镇痛的临床研究 [J] .实用药物与临床,2011,14 (2): 116-118.
[13] 郑 彬, 傅文婷,曾彦茹,等 .老年患者蛛网膜下腔注射左旋布比卡因、罗哌卡因和布比卡因运动阻滞效能的比较 [J].实用医学杂志, 2011,27(5):859-861.
[14] 成忠平,苑妍新,陈卫民. 0.25%左旋布比卡因与罗哌卡因用于小儿骶管阻滞时效性的比较 [J].实用药物与临床,2010,13(1): 18-19.
[15] 陆 蓉,马国平.腰硬联合麻醉不同注药速度对麻醉效果的影响[J].医学综述,2016,22 (12):2422-2423.
PDF(711 KB)
