王盛明　周渊

【摘要】 目的：分析膝關节镜手术给予小剂量罗哌卡因腰硬联合麻醉的效果。方法：选取2012年5月-2015年5月笔者所在医院收治的实施关节镜手术并术中实施腰硬联合麻醉的患者96例，依照随机数字表法分为研究组和对照组，每组48例。两组均实施腰硬联合麻醉，对照组取浓度0.5%罗哌卡因3 ml实施导管内缓慢推注，若麻醉效果不理想，每15分钟可追加注射0.5%罗哌卡因5 ml，直至手术结束。研究组诱导及追加注射药物及药物体积同对照组，但浓度减半，即应用罗哌卡因浓度为0.25%。对比两组麻醉阻滞效果、麻醉恢复效果、全程生命体征变化及麻醉不良反应。结果：研究组感觉阻滞起效及维持时间、平面固定时间、运动阻滞起效及维持时间、麻醉起效期间处于改良Bromage评分的各分级时间与对照组比较差异均无统计学意义（P>0.05）。研究组感觉及运动阻滞恢复时间均显著快于对照组（P<0.05）。两组治疗前心率及平均动脉压比较差异均无统计学意义（P>0.05），研究组治疗全程心率及呼吸均保持稳定（P>0.05）。对照组心率在麻醉5 min、10 min、手术完成时均显著下降（P<0.05），平均动脉压在麻醉5 min及10 min时均显著下降（P<0.05），手术完成时与治疗前比较差异无统计学意义（P>0.05）。研究组不良反应率为14.58%，显著低于对照组的47.92%（P<0.05）。结论：膝关节镜手术给予小剂量罗哌卡因腰硬联合麻醉其麻醉效果同正常剂量，能稳定术中血流动力学水平及生命体征，更能促进麻醉阻滞恢复，降低麻醉剂不良反应。

【关键词】 膝关节镜手术； 罗哌卡因； 腰硬联合麻醉

中图分类号 R614.4 文献标识码 A 文章编号 1674-6805（2016）6-0001-03

Effect of Low Dose of Ropivacaine for Combined Spinal-epidural Anesthesia in Arthroscopic Knee Surgery/WANG Sheng-ming，ZHOU Yuan.//Chinese and Foreign Medical Research，2016，14（6）：1-3

【Abstract】 Objective：To analyze the effect of low dose of Ropivacaine for combined spinal-epidural anesthesia in the arthroscopic knee surgery.Method：96 patients treated in this hospital who received the combined spinal-epidural anesthesia in the arthroscopic knee surgery from May 2012 to May 2015 were selected，they were divided into the the research group and the control one according to the random number table，with 48 cases in each group.Patients in these two groups all received the combined spinal-epidural anesthesia.Patients in the control group received the slow injection of 0.5% Ropivacaine by 3 ml.In case of the poor anaesthetic effect，5 ml of 0.5% Ropivacaine was injected every 15 min till the end of operation.The inducing drug and additional injecting drug and the volume for patients in the research group were the same as the ones in the control group，but the concentration was the half，namely 0.25% Ropivacaine.The effect of block anesthesia and anesthesia recovery，changes in the vital signs during the whole course and adverse reactions of anesthesia were compared between two groups.Result：There were no significant difference in the effect of sensory block and maintaining time，flat fixed time，motor block and maintaining time and time for each stage with the modified Bromage score during the anesthesia among patients in the two groups（P>0.05）.The recovery time of sensory and motor block for patients in the research group were significantly faster than those in the control group（P<0.05）.There were no significant difference in the heart rate and mean arterial pressure before the operation between two groups（P>0.05），while the heart rate and respiration for patients in the research group were all stable during the operation（P>0.05）.The heart rate for patients in the control group were significantly decreased at 5 min and 10 min of anesthesia and at the completion of operation（P<0.05），while the mean arterial pressure were significantly decreased at 5 min and 10 min of anesthesia（P<0.05），but it was recovered to the level before the operation and there was no significant difference at the completion of operation（P>0.05）.The rate of adverse reactions for patients in the research group was 14.58%，which was significantly lower than 47.92% of the control group（P<0.05）.Conclusion：The anesthetic effect with the small dose of Ropivacaine for combined spinal-epidural anesthesia in the arthroscopic knee surgery is the same as the one with the normal dose，which can stabilize the hemodynamic situation and vital signs during the operation，promote the recovery from the anesthesia block and reduce the adverse reactions of anesthetics.

【Key words】 Arthroscopic knee surgery； Ropivacaine； Combined spinal-epidural anesthesia

First-authors address： Yunchuan Hospital in Neijiang City，Neijiang 641001，China

doi：10.14033/j.cnki.cfmr.2016.6.001

在临床上，腰硬联合麻醉已广泛应用于外科手术之中。该麻醉方案以其优异的麻醉效果，较好地保障了外科手术的顺利进行[1]。当前，临床实施该项麻醉方案的首选药物为盐酸罗哌卡因[2]。而在腰硬联合麻醉中，临床多将盐酸罗哌卡因的剂量应用偏大，以保障麻醉效果，然而，大剂量给予罗哌卡因后，患者生命体征可发生不稳定，且术后麻醉相关并发症也显著上升[3]。为此，笔……