低位肛瘘手术应用小剂量2%利多卡因联合两点扇形麻醉法的可行性研究
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摘要
目的探讨小剂量2%利多卡因骶管麻醉联合两点扇形麻醉法在低位肛瘘中的应用效果及安全性。方法随机选取2015年1-12月河北省老年病医院因肛肠疾病住院的120例患者作为研究对象,按照随机数字法分为观察组和对照组,每组60例。所有患者均采取手术治疗,其中观察组采用小剂量2%利多卡因骶管麻醉联合两点扇形麻醉法,对照组患者则采用鞍麻。观察两组患者麻醉阻滞前后血压及心率变化,记录并比较两组患者的感觉、运动阻滞维持时间、麻醉效果、术后疼痛程度及不良反应情况。结果两组患者麻醉阻滞后各时段的MAP、SpO_2及HR比较差异均无统计学意义(P>0.05);与观察组比较,对照组患者的感觉和运动阻滞时间均明显延长,术后肛门收缩恢复率及直肠牵拉反射率均处于较低水平(P<0.05)。观察组患者麻醉效果、术后VAS疼痛评分、术后轻度疼痛比例以及术后不良反应发生率等指标均明显优于对照组(P<0.05)。结论小剂量2%利多卡因骶管麻醉联合两点扇形麻醉可为临床手术提供较好的便利条件,患者应激反应以及术后疼痛轻,恢复时间短,安全性高。
Objective To investigate the effect and safety of small dose of 2% lidocaine sacral anesthesia combined with two-point sector anesthesia in the treatment of low anal fistula.Methods Totally 120 hospitalized patients with anorectal diseases in Hebei Geriatric Hospital from January to December 2015 were randomly selected as the research subjects.They were divided into observation group and control group according to random number method,60 patients in each group.All patients were treated by surgery,and observation group was treated with small dose of 2% lidocaine sacral anesthesia combined with two-point sector anesthesia,while control group was treated with saddle anesthesia.The changes of blood pressure and heart rate before and after anesthesia were observed,and the sensation,duration of motor block,anesthetic effect,degree of pain and adverse reactions were recorded and compared between the two groups.Results There was no significant difference in MAP,SpO_2 or HR between the two groups at different time intervals of anesthesia block(P>0.05).Compared with observation group,the time of sensory and motor block in control group was significantly prolonged,and the recovery rate of anal contraction and rectal traction reflex were at a lower level after operation(P<0.05).The anesthesia effect,VAS pain score,the proportion of mild pain and the incidence of adverse reactions in observation group were significantly better than those in control group(P<0.05).Conclusion Small dose of 2% lidocaine sacral anesthesia combined with two-point sector anesthesia can provide better convenience for clinical operation.Patients′ stress response and postoperative pain are mild and the recovery time is short with good safety.
Objective To investigate the effect and safety of small dose of 2% lidocaine sacral anesthesia combined with two-point sector anesthesia in the treatment of low anal fistula.Methods Totally 120 hospitalized patients with anorectal diseases in Hebei Geriatric Hospital from January to December 2015 were randomly selected as the research subjects.They were divided into observation group and control group according to random number method,60 patients in each group.All patients were treated by surgery,and observation group was treated with small dose of 2% lidocaine sacral anesthesia combined with two-point sector anesthesia,while control group was treated with saddle anesthesia.The changes of blood pressure and heart rate before and after anesthesia were observed,and the sensation,duration of motor block,anesthetic effect,degree of pain and adverse reactions were recorded and compared between the two groups.Results There was no significant difference in MAP,SpO_2 or HR between the two groups at different time intervals of anesthesia block(P>0.05).Compared with observation group,the time of sensory and motor block in control group was significantly prolonged,and the recovery rate of anal contraction and rectal traction reflex were at a lower level after operation(P<0.05).The anesthesia effect,VAS pain score,the proportion of mild pain and the incidence of adverse reactions in observation group were significantly better than those in control group(P<0.05).Conclusion Small dose of 2% lidocaine sacral anesthesia combined with two-point sector anesthesia can provide better convenience for clinical operation.Patients′ stress response and postoperative pain are mild and the recovery time is short with good safety.
引文
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[11] 刘涌,罗彧钰,田丽.肛肠科手术中小剂量布比卡因骶管阻滞联合电针技术对腹部牵拉反射的影响[J].中国临床研究,2017,30(9):1264-1266.
[12] 袁建虎,李天佐,杨茜芳,等.不同麻醉方法在非住院肛肠手术的应用[J].北京医学,2015,37(8):763-765,768.
[13] Kulkarni SV,Agarwal P,Nagraj K.To compare the outcome of minor anorectal surgeries under local anesthesia versus spinal anesthesia[J].Indian J Surg,2014,76(5):343-349.
[2] 李媛,王世禄,衣晓卓,等.4种麻醉方法在肛肠手术患者中的应用比较[J].中国综合临床,2016,32(2):105-108.
[3] 李响.美国麻醉医师协会分级在老年肝癌患者外科治疗风险评估中的作用[J].实用老年医学,2015,29(9):755-758.
[4] 高庆建,杨铁峥.肛肠疾病术后疼痛研究进展[J].长春中医药大学学报,2017,33(4):681-683.
[5] 吴艳,马丽,常海霞.术前负性情绪对直肠黏膜脱垂患者吻合器痔上黏膜环切术后疼痛的影响[J].医学临床研究,2016,33(5):901-903.
[6] Haghighi M,Sedighinejad A,Nabi BN,et al.Is spinal anesthesia with low dose lidocaine better than sevoflorane anesthesia in patients undergoing hip fracture surgery[J].Arch Bone Jt Surg,2017,5(4):226-230.
[7] Touzotjourde G,Relun A,Cesbron N,et al.Subarachnoid anesthesia in sedated calves undergoing umbilical surgery:comparison of procaine 2% and lidocaine 2% associated with xylazine 2[J].Veterinary Anaesth Analg,2017,44(5):1262.
[8] 方传奇.罗哌卡因腰麻-硬膜外联合麻醉用于肛肠手术的疗效分析[J].中国综合临床,2015,31(7):635-637.
[9] Ezz HAA,Elkala RS.Ultra-low-dose naloxone added to fentanyl and lidocaine for peribulbar anesthesia:a randomized controlled trial[J].Egyptian J Anaesth,2015,31(2):161-165.
[10] 徐敏逸,王静,柳娇,等.罗哌卡因复合舒芬太尼蛛网膜下腔阻滞用于肛肠手术的麻醉效果[J].江苏医药,2016,42(18):2010-2012.
[11] 刘涌,罗彧钰,田丽.肛肠科手术中小剂量布比卡因骶管阻滞联合电针技术对腹部牵拉反射的影响[J].中国临床研究,2017,30(9):1264-1266.
[12] 袁建虎,李天佐,杨茜芳,等.不同麻醉方法在非住院肛肠手术的应用[J].北京医学,2015,37(8):763-765,768.
[13] Kulkarni SV,Agarwal P,Nagraj K.To compare the outcome of minor anorectal surgeries under local anesthesia versus spinal anesthesia[J].Indian J Surg,2014,76(5):343-349.