郭　玲　王　姝　卢丽岩　李莲娣

1.牡丹江医学院第二附属医院病理科，黑龙江牡丹江157000曰2.牡丹江医学院第二附属医院人事科，黑龙江牡丹江157000曰3.牡丹江医学院第二附属医院麻醉科，黑龙江牡丹江157000

腰丛联合坐骨神经阻滞下足踝部手术患者的不同浓度罗哌卡因对比研究

郭玲1王姝2卢丽岩2李莲娣3▲

1.牡丹江医学院第二附属医院病理科，黑龙江牡丹江157000曰2.牡丹江医学院第二附属医院人事科，黑龙江牡丹江157000曰3.牡丹江医学院第二附属医院麻醉科，黑龙江牡丹江157000

目的探讨腰丛联合坐骨神经阻滞下足踝部手术患者的不同浓度罗哌卡因对比效果。方法选择本院行腰丛联合坐骨神经阻滞下足踝部手术的患者110例，随机分成实验组（0.25%罗哌卡因）和对照组（0.50%罗哌卡因），同时观察记录患者在术前、术中15 min、术中45 min、术后的OAA/S评分，统计患者的血流动力学参数、呼吸参数以及术后不良反应的发生率。结果实验组患者在手术开始后15 min、45 min和手术完成时，其OAA/S评分显著低于对照组（P<0.05）曰实验组患者术后不良反应发生率为5.45%，对照组发生率为21.82%，组间比较差异有统计学意义（字2=13.623，P=0.001）曰术中15 min时，实验组患者的SPO2、RR显著高于对照组，差异有统计学意义（P<0.05），两组患者在术中15 min时MAP和术前、术后比较，差异有统计学意义（P<0.05），两组患者的术中、术后的HR显著低于术前，差异有统计学意义（P<0.05）。结论腰丛联合坐骨神经阻滞下足踝部手术患者应用0.25%罗哌卡因麻醉效果最佳，具有良好的镇痛镇静效果，其不会明显抑制患者的呼吸和血流循环，同时明显降低术后不良反应的发生率，值得在临床广泛使用。

罗哌卡因；足踝部手术；坐骨神经阻滞；麻醉；血液动力学

［Abstract］Objective To explore the comparative effects of ropivacaine with different concentrations in the patients re鄄ceiving foot and ankle surgery under lumbar-sciatic nerve block.Methods 110 patients who were given foot and ankle surgery under lumbar-sciatic nerve block in our hospital were selected.They were randomly assigned to the experi鄄ment group(0.25%ropivacaine)and the control group(0.50%ropivacaine).OAA/S scores before the surgery,at 15 min and 45 min during the surgery and after the surgery were observed and recorded,and patients'hemodynamic parame鄄ters,respiratory parameters and incidence rate of postoperative adverse reactions were statistically analyzed.Results 15 min,45 min after the beginning of the surgery and upon completion of the surgery,the OAA/S scores in the patients in the experiment group were significantly lower than those in the control group(P<0.05);the incidence rate of postopera鄄tive adverse reactions in the experiment group was 5.45%,and the incidence rate was 21.82%in the control group. The differences were significant between the two groups(字2=13.623,P=0.001);parameters of SPO2,RR before and after the surgery in the experiment group were significantly higher than those in the control group,and the differences were significant(P<0.05).MAP parameters 15 min during the surgery in both groups were significantly different from those before and after the surgery(P<0.05).HR parameters during the surgery and after the surgery in both groups were sig鄄nificantly lower than those before the surgery,and the differences were significant(P<0.05).Conclusion Application of 0.25%ropivacaine for anesthesia is the most favorable method in the patients receiving foot and ankle surgery under lumbar-sciatic nerve block.It has favorable analgesic and sedative effects,and does not significantly inhibit patients' respiratory and blood circulation.It is also able to significantly reduce the incidence rate of postoperative adverse ef鄄fects,which is worthy of widespread clinical application.

［Key words］Ropivacaine;Foot and ankle surgery;Sciatic nerve block;Anesthesia;Hemodynamics

老年多伴有严重系统并发症，其足踝部手术麻醉方式在临床上一般会面临着极大的选择[1]。对老年患者行椎管内麻醉，会容易使其的学流动力学产生巨大波动，致使患者的呼吸循环系统功能障碍，影响患者的呼吸且易产生窒息，同时术后的恢复也是目前的研究难题[2]。神经阻滞由于对患者呼吸系统的影响较小，并且术后并发症和不良反应较小，因此，能够成为本类患者应用的一种麻醉方式[3]。……