【摘要】 目的观察罗哌卡因复合舒芬太尼蛛网膜下腔麻醉在经尿道前列腺电切术中的应用。方法选择北京市房山区第一医院2011年3月至2014年1月100例ASA I~Ⅲ级拟行经尿道前列腺电切术的患者,随机分为四组,分别在蛛网膜下腔给予0.5%罗哌卡因2.5 mg(LL组)、0.5%罗哌卡因2.5 mg复合舒芬太尼5μg(LLS组)、0.5%罗哌卡因5 mg(LH组)、0.5%罗哌卡因5 mg复合舒芬太尼5μg(LHS组)。观察四组患者在血液动力学、麻醉效果、不良反应、术后镇痛方面的差异。结果 LH组和LHS组在给药后1 min、3 min、5 min、10 min的平均动脉压明显低于LL组和LLS组(P<0.05),LLS组的心率在给药后5 min和10 min明显低于LHS组(P<0.05)。LH组和LHS组给药后30 min的感觉平面显著高于LL组和LLS组(P<0.05)。LH组和LHS组给药后的运动阻滞时间明显低于LL组和LLS组(P<0.05),而运动恢复时间明显高于LH组和LHS组(P<0.05)。LH组和LHS组给药后出现低血压和恶心呕吐的例数明显高于LL组和LLS组(P<0.05)。所有患者未出现瘙痒。术后6 h的疼痛评分LL组明显高于LLS组、LH组和LHS组(P<0.05)。术后6~24 h期间需要额外使用镇痛药物的人数LL组明显高于LLS组、LH组和LHS组(P<0.05)。LL组的患者满意度评分明显低于LLS组、LH组和LHS组(P<0.05)。结论 0.5%罗哌卡因2.5 mg复合舒芬太尼5μg蛛网膜下腔麻醉用于经尿道前列腺电切术更为有效、安全,而且副作用低。更多还原

【Abstract】 Objective To observe the application of different dosage of ropivacaine combined with or without sufentanil in spinal anesthesia for transurethral resection of prostate( TURP). Methods One hundred patients undergoing TURP in Fang Shan District No. 1 Hospital during March,2011 to January,2014 were randomly divided into four groups,patients in LL group were given with 0. 5% ropivacaine 12. 5 mg,patients in LLS group were given with 0. 5% ropivacaine 12. 5 mg and sufentanil 5μg,patients in LH group were given with 0. 5% ropivacaine 15 mg and patients in LHS group were given with 0. 5% ropivacaine 15 mg and sufentanil 5μg. All these drugs were injected into the subarachnoid space.Their physical status was grade 1,2,or 3 according to the criteria of Anesthesiologist Association of America( ASA). The hemodynamic parameters,anesthesia effect,side effects and visual analogue scale( VAS) were observed in patients of these four groups in 6 h after operation. Results The mean levels of arterial pressure( MAP) in group LH and group LHS at the time points of 1 minute,3 minutes,5 minutes and 10 minutes after anesthesia were significantly lower than those of group LL and group LLS( P < 0. 05). The heart rates( HR) in group LLS at the time points of 5 minutes and 10 minutes after anesthesia were significantly lower than those of group LHS( P < 0. 05). The level of sensory block at the time point of 30 minutes after the anesthesia in group LH and group LHS was significantly higher than that of group LL and group LLS( P < 0. 05).The motor block time in group LL and group LLS was significantly longer than that of group LH and group LHS( P < 0. 05),and the motor recovery time in group LL and group LLS was significantly shorter than that of group LH and group LHS( P < 0. 05). The incidence rates of nausea,vomiting and hypotension in group LH and group LHS were significantly higher than those of group LL and group LLS( P < 0. 05). No patient had been found to have itching in all these groups( P < 0. 05). VAS in 6h after operation in group LL was significantly higher than that of group LLS,group LH and group LHS( P < 0. 05),and more patients in group LL needed additional analgesics than patients in group LLS,group LH and group LHS( P < 0. 05). The satisfactory scores from patients of group LL were significantly lower than those of group LLS,group LH and group LHS( P < 0. 05). Conclusion Spinal anesthesia with ropivacaine( 0. 5%) 12. 5 mg combined with 5 μg sufentanil is more effective,safer with fewer side effects in patients receiving TURP.更多还原