作　　者： (曾恒）; (李俊）; (周述芝）;

机构地区： 西南医科大学附属第一医院麻醉科,四川泸州646000

出　　处： 《四川医学》 2017年第9期1036-1039,共4页

摘　　要： 目的观察氢吗啡酮复合罗哌卡因用于改良骶管阻滞的效果。方法 ASAⅠ~Ⅱ级择期行肛肠手术患者80例,每组40例,行改良骶管阻滞,随机分为H组和C组。H组:1%罗哌卡因5mL+2%利多卡因10mL+0.9%NS 5mL+盐酸氢吗啡酮0.3mg,C组:1%罗哌卡因5mL+2%利多卡因10mL+0.9%NS 5mL。观察并记录患者术中HR、MAP,麻醉起效时间及维持时间,术中直肠牵拉反射,术后3、6、12、24h VAS评分及术中及术后24h内不良反应发生情况。结果与C组比较,H组感觉阻滞起效时间短于对照组,感觉阻滞维持时间长于C组(P<0.05)。H组术中直肠牵拉反射少于C组(P<0.05),术后3h、6h、12h VAS评分H组低于C组(P<0.05),术后24h VAS评分两组差异无统计学意义(P>0.05)。结论骶管内使用氢吗啡酮可明显增强罗哌卡因的术后镇痛效果,缩短麻醉起效时间,延长镇痛时间,不良反应发生率低。 Objective To observe the effect of combined use of hydromorphone and ropivacaine in modified sacral block. Methods 80 cases underwent elective anorectal surgery at grade ASA I - II ,40 cases in each group,which underwent modified sacral block,randomly divided into group H and group C. Group H：5mL of 1% ropivacaine ＋ 10mL of 2% lidocaine ＋ 5mL of 0. 9% NS ＋ 0. 3mg of dihydromorphinone hydrochloride, group C ： 5mL of 1% ropivacaine ＋ 10mL of 2% lidocaine ＋ 5mL 0. 9% NS. The intraoperative HR, MAP, onset timeand duration time of anesthesia, intraoperative rectal traction reflex, VAS score at 5,6, 12,24h after operation, and adverse events during operation and within 24 hours after surgery were observed and recorded. Results Compared with group C, the onset time of sensory block in group H was shorter than that of control group, and the duration of sensory block was longer than that of group C （P 〈 0. 05）. Theintraoperative rectal traction reflex in group H was less than that in group C （P 〈 0. 05 ） , and the VAS scores of 3h ,6h, 12hafter operation in group H were lower than in group C （P 〈 0. 05 ） , and there wasno significant difference in VAS score between the two groups at 24 hours after operation （P 〉 0. 05）. Conclusion The application of hydromorphone in the sacral canal can significantly increase the effect of ropivacaine on postoperative analgesia, shorten the onset time of anesthesia and prolong the time of analgesia, and the incidence rate of adverse reactions is low.

关 键 词： 氢吗啡酮 罗哌卡因 利多卡因 骶管阻滞