摘要
目的探讨利多卡因复合小剂量右美托咪定骶管阻滞用于痔上直肠黏膜环切钉合术(procedure for prolapsing hemorrhoids,PPH)的安全性和麻醉效果。方法选择2019年6~7月北京市肛肠医院择期行PPH的手术患者90例,美国麻醉医师协会(American Society of Anesthesiologist,ASA)分级Ⅰ~Ⅱ级,随机分为3组:A组,1%利多卡因25 ml;B组,1%利多卡因25 ml+0.3μg/kg右美托咪定;C组,1%利多卡因25 ml+0.5μg/kg右美托咪定。记录术中麻醉起效时间、麻醉维持时间、镇痛持续时间,以及麻醉操作前、麻醉后30 min、麻醉后2 h 3个时间点的Ramsay评分,术中牵拉反应,术后VAS疼痛评分及相关不良反应发生情况。结果B组与C组麻醉起效时间、麻醉维持时间、镇痛持续时间、牵拉反应,均优于A组(P<0.05),术后1 h,B组清醒程度、依从性优于C组,C组有2例术后出现心动过缓,1例出现尿潴留。结论1%利多卡因复合右美托咪定0.3μg/kg骶管阻滞用于PPH手术,血流动力学稳定,麻醉效果满意,无明显不良反应,与较高剂量(0.5μg/kg)相比,更适用于PPH手术。
Objective To investigate the safety and anesthetic effect of the caudal block with lidocaine composited with small dose of dexmedetomidine for procedure for prolapsing hemorrhoids(PPH).Methods Ninety patients,ASAⅡorⅡ,scheduled for PPH,were divided into three double blind and randomized groups(30 cases in each group).All patient received a single caudal block with 1%lidocaine 25 ml,the local anesthetic solution was added dexmedetomidine 0.3μg/kg in group B,and 0.5μg/kg in group C.The onset time of caudal block,the duration of analgesia,the postoperation effective analgesia duration,the Ramsay score at three time points(before anesthesia,30 minutes after anesthesia,2 hours after anesthesia),the intraoperative traction action,the postoperative VAS pain score,and the related adverse reactions were recorded.Results The group B and group C were superior to group A in the onset time of caudal block,the duration of analgesia,the postoperation effective analgesia duration,and the intraoperative traction action(P<0.05).One hour after surgery,the group B was superior to group C in the level of consciousness and the compliance of the patient.Two cases of postoperative bradycardia and one case of urinary retention were found in group C.Conclusions For PPH,the addition of dexmedetomidine 0.3μg/kg to1%lidocaine in caudal block has stable hemodynamics conditions and the anaesthesia effect is satisfactory,without evident adverse reaction.And it is more applicable than the higher doses of dexmedetomidine 0.5μg/kg in caudal block for PPH.
作者
张旭光
袁建虎
杨志军
杨茜芳
Zhang Xuguang;Yuan Jianhu;Yang Zhijun;Yang Qianfang(Department of Anesthesiology,Beijing Rectum Hospital(Beijing Erlong Lu Hospital),Beijing 100120,China)
出处
《北京医学》
CAS
2020年第2期132-135,共4页
Beijing Medical Journal
关键词
右美托咪定
利多卡因
PPH
骶管阻滞
dexmedetomidine
lidocaine
procedure for prolapsing hemorrhoids(PPH)
caudal block
