微创医学

目的观察比较0.3%轻比重罗哌卡因与0.3%轻比重布比卡因单侧腰麻应用于单侧膝关节镜手术的麻醉效果。方法选择腰麻下单侧膝关节镜手术患者48例,ASAⅠ或Ⅱ级,随机分为R组和B组两组,每组24例,轻比重腰麻药配方:R组:0.75%罗哌卡因2 mL+注射用水3 mL配成0.3%轻比重罗哌卡因;B组:0.75%布比卡因2 mL+注射用水3 mL配成0.3%轻比重布比卡因。观察两组患者感觉、运动阻滞起效时间、恢复时间和不良反应。术中连续监测呼吸和循环系统状况。结果两组患者患侧肢体麻醉效果、最高感觉阻滞平面相似,但R组感觉阻滞起效慢于B组,维持时间短于B组(P<0.05);下肢运动阻滞程度低于B组,恢复较B组快(P<0.05)。R组健侧肢体感觉和运动阻滞均较B组轻,恢复也快。B组易出现尿潴留;两组血流动力学均比较稳定。结论两种轻比重局麻药单侧腰麻均有效应用于单侧膝关节镜手术。0.3%轻比重等剂量的罗哌卡因和布比卡因相比较,罗哌卡因对下肢运动影响小,术后下肢运动恢复较布比卡因快,不良反应少,血流动力学稳定,更适用于手术时间短的膝关节镜手术。

Objective To compare the analgesic effect of hypobaric ropivacaine 0． 3% to hypobaric bupivacaine 0． 3% in unilateral spinal anesthesia in patient undergoing unilateral knee arthroscope operation． Methods 48 patients ( ASA Ⅰ －Ⅱ) scheduled for unilateral knee arthroscope operation were selected and randomized into two groups ( 24 cases each) : group R( 0． 3% ropivacaine was made by a combination of 0． 75% ropivacaine and 3mlwater for injection) and group B ( bupivacaine 0． 3% was made by made by a combination of 0． 75% bupivacaine and 3mlwater for injection dose = 3ml) ． The onset and duration of motor and sensory blocks were compared between the 2 groups． The side effects were also recorded． Besides，we monitored the respiratory and circulatory system during operation． Results The two groups had similar quality of analgesia and the same highest block level on the limb，but the onset of sensory blocks was slower and lasted for shorter time in group R than in group B( P ＜ 0.05) ． The extent of motor block of lower limb was lower and restored more quickly in group R than in group B． Both motor and sensory block in healthy limb were slighter and restored sooner in group R than in group B． More cases of uroschesis were reported in group B，but hemodynamics of both groups was rather stable． Conclusions Both hypobaric local anesthetics for unilateral spinal anesthesia can be effectively used in unilateral knee arthroscope operation． But compared with bupivacaine，isodose 0． 3% hypobaric ropivacaine was more suitable in knee arthroscope operation that lasts short time，for it has less effect on lower limb motion，quicker restoration，less side effect，and more stable hemodynacmics than bupivacaine．