岑燕遗??蓝岚??赵子良

[摘要] 目的 探讨吻合器痔上黏膜环切术（PPH）日间手术时鞘内注射罗哌卡因的最佳剂量。 方法 选择2016年6月～2017年2月行吻合器痔上黏膜环切术日间手术的患者60例，随机分成三组，每组20例，分别鞘内注射罗哌卡因7.5、10、15mg，观察改良Bromage评分、达最大运动阻滞时间、运动阻滞持续时间、鞘内注射药物至可行走时间、鞘内注射药物至排尿时间、术中运动阻滞和术中镇痛。 结果 三组改良Bromage评分和达最大运动阻滞时间相近（P>0.05），至于运动阻滞持续时间、从鞘内注射药物至可行走时间以及从鞘内注射药物至排尿时间，则以15mg组最长，10mg组次之，7.5mg组最短，三组之间差异有统计学意义（P<0.05）。所有患者的术中运动阻滞和术中镇痛完全。 结论 在用于PPH日间手术时，鞘内注射罗哌卡因7.5mg的麻醉、镇痛质量和运动阻滞程度与10mg和15mg相似，可满足手术要求，且可明显缩短运动阻滞持续时间。

[关键词] 鞘内；罗哌卡因；剂量；吻合器痔上黏膜环切术

[中图分类号] R614 [文献标识码] A [文章编号] 2095-0616（2017）11-158-04

Best dosage of ropivacaine by intrathecal injection in application of day surgery of procedure for prolapse and hemorrhoids

CEN Yanyi LAN Lan ZHAO Ziliang

Department of Anesthesiology，First Affiliated Hospital to Guangzhou Medical University，Guangzhou，510120，China

[Abstract] Objective To explore best dosage of ropivacaine by intrathecal injection in application of day surgery of procedure for prolapse and hemorrhoids （PPH）. Methods 60 patients undergoing day surgery of procedure for prolapse and hemorrhoids from June 2016 to February 2017 were selected and they were randomly divided into three groups， with 20 in each.They were respectively given ropivacaine of 7.5，10 and 15mg by intrathecal injection. Modified Bromage score，time for reaching maximum motor block，duration of motor block，time from drug by intrathecal injection to walking，time from drug by intrathecal injection to urination，intraoperative motor block and intraoperative analgesia were observed. Results Modified Bromage score and time for reaching maximum motor block in three groups were similar（P>0.05）.Duration of motor block，time from drug by intrathecal injection to walking，time from drug by intrathecal injection to urination in the 15mg group were the longest followed by the 10mg group and the 7.5mg group and those of the 7.5mg group were the shortest. There were statistical difference between three groups（P<0.05）.Intraoperative motor block and intraoperative analgesia of all patients were adequate. Conclusion When applied in day surgery of procedure for prolapse and hemorrhoids，anesthesia， quality of analgesia and degree of motor block of ropivacaine of 7.5mg by intrathecal injection are similar to those of ropivacaine of 10mg and 15mg by intrathecal injection.It can fulfill the demands of procedure and significantly shorten the duration of motor block.

[Key words] Intrathecal；Ropivacaine；Dosage；Procedure for prolapse and hemorrhoids

1993年吻合器痔上黏膜環切术（procedure for prolapse and hemorrhoids， PPH）开始用于治疗脱肛和痔[1]。较之传统的痔切除术，PPH术后不适发生率较低，运动神经阻滞恢复较快[2-3]，因而适合作为日间手术开展，而术后早期恢复则主要取决于麻醉技术，尤其是局麻药起效时间、作用持续时间以及运动阻滞恢复时间。本研究比较了鞘内注射三种不同剂量的罗哌卡因的临床资料，试图找到PPH日间手术时鞘内注射罗哌卡因的最佳剂量。

1 资料与方法

1.1 一般资料

选择2016年6月～2017年2月因重度内痔拟行PPH日间手术的成年患者60例，男36例，女24例，年龄38～61岁，ASAⅠ～Ⅱ级，所有患者均无心脑血管重大疾病，心、肺、肝、肾及凝血功能无异常。入选对象随机均分为三组，三组间年龄、性别构成比、体重和身高等差异均无统计学意义（P>0.05）。研……