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| 罗哌卡因腰麻用于椎间孔镜下腰椎间盘摘除术的适宜浓度 |
| Suitable concentration of ropivacaine for spinal anesthesia in percutaneous endoscopic lumbar discectomy |
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| DOI：10.12089/jca.2019.06.008 |
| 中文关键词: 腰麻 罗哌卡因 椎间孔镜手术 腰椎间盘摘除术 |
| 英文关键词: Spinal anesthesia Ropivacaine Percutaneous endoscopic lumbar discectomy Lumbar discectomy |
| 基金项目: |
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| 中文摘要: |
目的 观察轻比重等容量不同浓度罗哌卡因腰麻用于椎间孔镜下腰椎间盘摘除术的临床效果。
方法 选择2017年6月至2018年2月就诊的L4—L5和L5—S1椎间盘突出症患者75例，男40例，女35例，年龄40~65岁，BMI 20~26 kg/m2，ASA Ⅰ或Ⅱ级。按照随机数字表法分三组：0.15%罗哌卡因组（R0.15组）、0.18%罗哌卡因组（R0.18组）和0.2%罗哌卡因组（R0.2组），每组25例。轻比重低浓度罗哌卡因腰麻下行经皮椎间孔镜腰椎间盘切除术，在腰穿针回抽脑脊液通畅后，R0.15组注入0.15%罗哌卡因5 ml，R0.18组注入0.18%罗哌卡因5 ml，R0.2组注入0.2%罗哌卡因5 ml。记录感觉神经阻滞情况，包括感觉阻滞起效时间、最高痛觉阻滞平面、最高痛觉阻滞时间、麻醉持续时间。记录运动神经阻滞情况，包括运动阻滞起效时间、运动阻滞恢复时间、Bromage分级<2分、2~4分和>4分的例数以及术中疼痛感受分级情况。
结果R0.2组最高痛觉阻滞平面高于R0.18组和R0.15组，且R0.18组高于R0.15组。R0.2组麻醉持续时间明显长于R0.18组和R0.15组（P<0.05），且R0.18组明显长于R0.15组（P<0.05）。R0.2组运动阻滞起效时间明显短于R0.15组和R0.18组（P<0.05），运动阻滞恢复时间明显长于R0.15组和R0.18组（P<0.05），且R0.18组明显长于R0.15组（P<0.05）。R0.2组和R0.18组Bromage评分<2分的比例明显高于R0.15组（P<0.05）。R0.2组和R0.18组术中感受无痛的比例明显低于R0.15组（P<0.05），轻、中度疼痛的比例明显高于R0.15组（P<0.05）。三组均无一例Bromage评分>4分、术中感受为重度疼痛。
结论 椎间孔镜下腰椎间盘摘除术麻醉适宜腰麻浓度和剂量为0.18%罗哌卡因5 ml，在同等容量前提下较0.15%罗哌卡因有效，较0.2%罗哌卡因对患者下肢运动影响小。 |
| 英文摘要: |
Ojective To observe the clinical effect of different concentrations of ropivacaine spinal anesthesia for the treatment of lumbar discectomy under intervertebral foramen.
Methods Sevety-five patients with L4-5 and L5-S1 disc herniation from June 2017 to February 2018 were enrolled. There were 40 males and 35 females, aged 40 - 65 years, BMI 20 - 26 kg/m2, falling into ASA physical status Ⅰ or Ⅱ. Three groups were divided according to the random number table method: 0.15% ropivacaine group (group R0.15), 0.18% ropivacaine group (group R0.18) and 0.2% ropivacaine group (group R0.2), 25 cases in each group. Low-concentration ropivacaine spinal anesthesia with percutaneous transforaminal lumbar discectomy, patients in group R0.15 were injected with 0.15% ropivacaine 5 ml, patients in group R0.18 were injected with 0.18% ropivacaine 5 ml, patients in group R0.2 were injected with 0.2% ropivacaine 5 ml. Sensory nerve block was recorded, including the onset time of sensory block, the highest pain block, the highest pain block time, and the duration of anesthesia. The motor block was recorded, including the onset time of exercise block, the recovery time of exercise block, the number of Bromage grades < 2 points, 2 - 4 points and > 4 points, and the grade of pain perception during surgery.
Results The highest pain block level in group R0.2 was higher than that in group R0.18 and group R0.15, and that in group R0.18 was higher than that in group R0.15 (P < 0.05). The duration of anesthesia in group R0.2 was significantly longer than that in groups R0.15 and R0.18 (P < 0.05), and that in group R0.18 was significantly longer than that in group R0.15 (P < 0.05). The onset time of exercise block in group R0.2 was significantly shorter than that in groups R0.15 and R0.18 (P < 0.05), and the recovery time of motor block was significantly longer than that in groups R0.15 and R0.18 (P < 0.05), that in group R0.18 was significantly longer than that in group R0.15 (P < 0.05). The proportion of Bromage score < 2 points in group R0.2 and group R0.18 was significantly higher than that in group R0.15 (P < 0.05). The ratio of painlessness in the group R0.2 and the group R0.18 was significantly lower than that in group R0.15 (P < 0.05). The proportion of mild to moderate pain was significantly higher than that in group R0.15 (P < 0.05). None of the three groups had a Bromage score > 4 points, and patients with severe pain during the operation.
Conclusion The most suitable concentration is 0.18% of ropivacaine with a volume of 5 ml for the percutaneous endoscopic lumbar discectomy, it is more effective than 0.15% and less impact than 0.2% of ropivacaine on legs movement. |
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