摘要
目的观察超声辅助定位不同椎间隙穿刺腰麻(蛛网膜下腔阻滞麻醉)在吻合器痔上黏膜环切术(PPH)中的应用。方法选择2019年3-8月莆田学院附属医院择期行PPH手术的患者80例,根据随机数字表法分为A、B组,每组40例。A组超声辅助定位L2/3椎间隙穿刺,B组超声辅助定位L3/4椎间隙穿刺,2组蛛网膜下腔均注入罗哌卡因14 mg。比较2组感觉阻滞情况,监测循环功能、麻醉效果评定及麻醉期间不良反应。结果A组最高感觉阻滞平面高于B组,差异有统计学意义(P<0.05);感觉阻滞起效时间、感觉平面固定时间、感觉阻滞持续时间,2组比较差异均无统计学意义(P>0.05)。在感觉阻滞平面出现时(T1)、上吻合器时(T2)A组收缩压、舒张压、平均动脉压低于B组(P<0.05),A组心率在T2时高于B组(P<0.05)。A、B组在肛门痛觉阻滞、肛门松弛程度方面均达到手术要求,术中A组未出现牵拉反应,A组低血压发生率高于B组(P<0.05)。结论超声辅助定位L2/3椎间隙穿刺注射罗哌卡因14 mg进行蛛网膜下腔阻滞能够满足PPH手术的镇痛需求,术中无手术牵拉反应,但对循环功能有影响。
Objective To investigate the application of ultrasound-assisted localization of different intervertebral space puncture Spinal analgesia in PPH surgery.Methods 80 cases of patients with PPH surgery in the affiliated hospital of Putian University from March 2019 to Augest 2019 were selected and divided into A group and B group,according to random number table method,40 cases in each group.Ultrasound assisted localization of L2/3 intervertebral space puncture in group A and L3/4 intervertebral space puncture in group B;ropivacaine 14 mg was injected into subarachnoid space in both groups.Observation of sensation block,monitoring of circulation function,evaluation of anesthetic effect and recording of adverse reactions during anesthesia.Results The highest level of sensory block in group A was significantly higher than that in group B(P<0.05).The onset time of sensory block,the fixed time of sensory plane and duration of sensory block in two groups showedno significant difference(P>0.05).SBP、DBP、MAP in group A were significantly lower than those in group B at T1 and T2 time points(P<0.05),HR of group A was significantly higher than that of group B at T2 time points(P<0.05).Satisfactory effects on pain blockage and anal sphincter relaxation were achieved in group A and group B.The incidence of hypotension in group A was significantly higher than that in group B(P<0.05).Conclusion Ultrasound-assisted localization of L2/3 intervertebral space puncture injection of 14 mg ropivacaine for subarachnoid anesthesia can meet the analgesic needs of PPH surgery,no discomfort such as surgical traction,but has an effect on circulation function.
作者
林新强
陈育人
林建新
陈晓
蔡茂恩
何莹茜
LIN Xinqiang;CHEN Yuren;LIN Jianxin(Department of Anesthesiology,Affiliated Hospital of Putian University,Fujian Province,Putian 351100,China)
出处
《临床合理用药杂志》
2020年第5期10-11,14,共3页
Chinese Journal of Clinical Rational Drug Use
关键词
超声定位
罗哌卡因
腰麻
吻合器痔上黏膜环切术
Ultrasonic localization
Ropivacaine
Spinal analgesia
Procedure for prolapse and hemorrhoids
