不同浓度剂量罗哌卡因腰麻对排尿功能影响临床观察.docVIP

不同浓度剂量罗哌卡因腰麻对排尿功能影响临床观察 　 作者：蔡铁良，蔡英蔚，吴洪坤，胡宏强，高鹏，沈七襄 【摘要】 　　目的 观察不同剂量罗哌卡因腰麻对排尿功能的影响。方法 择期肛门会阴部手术84例，顺序分为7组取不同浓度剂量的罗哌卡因（0.1%3 mg 、0.25% 3 mg、0.25% 5 mg、0.375% 5 mg、0.375% 7.5 mg、0.5% 7.5 mg、0.5% 10 mg）行腰麻。观察麻醉效果、平面、BP、HR、SpO2、Bromage评分、术后24 h 排尿功能（无障碍自动排尿、轻度障碍自行排尿、尿潴留）。结果 全组麻醉镇痛、肌松满意，麻醉平面多在S1呈鞍状；BP、HR、SpO2无明显改变，Bromage评分多为0分，24 h 排尿功能无障碍52例(62%)，轻度障碍17例(20%)，尿潴留15例(18%)，其中0.1%～0.375% 3～5 mg 的1～4组尿潴留2例(4.2%)，第7组0.5% 10 mg 尿潴留7例(58%)，两者比较差异有显著统计学意义(Plt;0.01)。结论 0.1%～0.25% 3～5 mg 重比重罗哌卡因腰麻用于肛门会阴部短小手术，足以满足手术要求，镇痛完全，肌松满意，麻醉平面局限，对BP、HR、SpO2几乎无影响，可显著减少麻醉因素对排尿功能的影响，值得采用。 【关键词】 罗哌卡因；腰麻；排尿 　　Abstract： Objective To observe the urination effect of spinal anesthesia with different dose of ropivacaine. Methods A total of 84 cases of selective anal and perineal operation were chosen. They were divided into 7 groups with spinal anesthesia respectively with 0.1% (3mg), 0.25% (3mg), 0.25% (5mg), 0.375% (5mg), 0.375% (7.5mg), 0.5% (7.5mg) and 0.5% (10mg) of hyperbaric ropivacaine. The anesthesia effect, level, blood pressure (BP), heart rate (HR), oxygen saturation of pulse (SpO2), Bromage score and 24-hour urination function were recorded. The urination function was classified from no dysuria to urinary retention.Results The anesthesia effects were satisfactory. The levels were most down to S1. BP, HR and SpO2 were stable. The Bromage scores were most at zero. There were 52 cases without dysuria, 17 cases with slight dysuria, and 15 cases with urinary retention. Urinary retention were most common in 0.5% (10mg) group. Conclusion It is suggested that 0.1%-0.25% (3-5mg) of hyperbaric ropivacaine is satisfactory when applied to anal and perineal operation. Also, ropivacaine within the concentration range almost brings about no adverse effect on urination function. 　　Key words： ropivacaine; spinal anesthesia; urination 术后尿潴留是肛肠病术后常见的并发症，患者十分痛苦，发生率高达38%～52%［1］，其原因是多方面的。本研究采用不同浓度和剂量罗哌卡因腰麻行肛门会阴部手术观察麻醉因素对排尿功能的影响，现报告如下。 　　1 资料与方法 　　1.1 一般资料 　　择期ASAⅠ～Ⅱ级肛门会阴部手术84例，男 56例，女 28例，年龄（36.5±15.5）岁，体重（