宋建阳　陈毓铭

【摘要】 目的：評价在肛肠手术中应用25G细针小剂量腰麻和常规腰麻效果与安全性差异。方法：选择2016年2月-2017年2月于笔者所在医院进行肛肠手术的92例患者，随机分为试验组（46例）和对照组（46例），试验组采用25G细针使用小剂量1 ml 0.75%布比卡因进行腰麻，对照组采用常规22G穿刺针给予2 ml 0.75%布比卡因进行腰麻。比较两组患者的麻醉1次成功率、起效时间和持续时间，对比两组术后头痛、低血压和尿潴留等发生情况及下肢肌力和自主排尿恢复时间。结果：试验组和对照组的1次成功率分别为84.78%（39/46）和65.22%（30/46），试验组头痛发生率和疼痛程度、低血压及尿潴留发生率、下肢肌力和自主排尿恢复时间均显著低于对照组，差异均有统计学意义（P<0.05），两组起效时间和持续时间差异无统计学意义（P>0.05）。结论：与常规腰麻相比，在肛肠手术中应用25G细针小剂量腰麻，麻醉1次成功率较高，可以显著降低术后头痛、低血压和尿潴留等不良反应的发生风险，明显减少术后恢复时间，值得推广。

【关键词】 25G细针； 腰麻； 小剂量； 肛肠手术

doi：10.14033/j.cnki.cfmr.2017.32.009 文献标识码 B 文章编号 1674-6805（2017）32-0019-02

Comparison of 25G Fine Needle with Small Dose Lumbar Anesthesia and Conventional Lumbar Anesthesia in Anorectal Surgery/SONG Jianyang CHEN Yuming.//Chinese and Foreign Medical Research，2017，15（32）：19-20

【Abstract】 Objective：To evaluate the effect and safety of 25G fine needle with small dose of lumbar anesthesia and conventional lumbar anesthesia in anorectal surgery.Method：92 cases of anorectal surgery from February 2016 to February 2017 in our hospital were randomly divided into experimental group（46 cases） and control group（46 cases），the experimental group used 25G needle with low dose 1 ml 0.75% bupivacaine spinal anesthesia，the control group using conventional 22G puncture needle for 2 ml 0.75% bupivacaine spinal anesthesia.The success rate of 1 time of anesthesia，the time of onset and the duration of the two groups were compared.The postoperative headache，hypotension and urinary retention were compared between the two groups，and the lower limb muscle strength and the time of urination recovery were compared.Result：1 time success rate of the experimental group and the control group were 87.78%（39/46） and 65.22%（30/46），in the experimental group，the incidence of headache and pain，hypotension，and the incidence of urinary retention，lower limb muscle strength and the recovery of urination time were significantly lower than those of the control group（P<0.05）.There were no statistical differences between the two groups of the onset and duration time（P>0.05）.Conclusion：Compared with conventional spinal anesthesia，using 25G needle with small dose spinal anesthesia in anorectal surgery，1 time success rate of anesthesia is higher，has the lower risk of hypotension and headache，urinary retention and other adverse reactions after operation，significantly reduce postoperative recovery time，is worthy of promotion.

【Key words】 25G fine needle； Lumbar anesthesia； Small dose； Anorectal surgeryendprint

First-authors address：Affiliated Peoples Hospital of Quanzhou Medical College，Quanzhou 362000，China

肛肠疾病（如痔疮、肛周脓肿和肛瘘等）严重影响患者的生活质量，大多需要进行手术治疗。肛肠部位的神经极为敏感，因此，肛肠手术麻醉效果对手术的进程有着重要影响。目前常用于肛肠手术的麻醉方式有静脉麻醉、腰麻、硬膜外阻滞和骶管阻滞等，选择不良反应少、恢复时间快的麻醉方式可以促进患者术后康复，提高手术成功率[1]。为了评价在肛肠手术中应用25G细针小剂量腰麻和常规腰麻效果与安全性差异，现将笔者所在医院所做的一项随机对照试验汇报如下。……