不同比重布比卡因对麻醉后患者肢体幻像的影响比较研究
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摘要
目的研究不同比重盐酸布比卡因混合液用于腰硬联合麻醉下行下腹部和下肢手术的麻醉阻滞效果及对患者发生肢体幻像现象的影响。方法回顾性分析ASAⅠ～Ⅱ级拟在腰硬联合麻醉下行下腹部和下肢手术的患者192例,按照采用盐酸布比卡因混合液比重的不同分为A组(轻比重盐酸布比卡因混合液蛛网膜下腔阻滞麻醉组,68例)和B组(重比重盐酸布比卡因混合液蛛网膜下腔阻滞麻醉组,124例),比较两组麻醉期间血流动力学、麻醉阻滞效果、肢体幻像发生情况及不良反应发生情况。结果 A组蛛网膜下腔阻滞后5 min的MBP明显低于入室后5 min(P <0.05);B组蛛网膜下腔阻滞后5 min的MBP及HR明显低于A组及同组入室后5 min(P <0.05),两组其余各时间点各指标比较无统计学差异(P> 0.05)。A组麻醉后感觉阻滞起效时间、达到麻醉感觉阻滞最高平面时间长于B组,运动、感觉神经阻滞持续均短于B组(P <0.05)。A组无肢体幻像发生,B组124例(71.77%)发生肢体幻像。结论与重比重盐酸布比卡因相比,轻比重盐酸布比卡因用于腰硬联合麻醉下行下腹部手术和下肢手术,对患者的血流动力学影响较小,不良反应发生率低,且无肢体幻像发生,应用更为安全。
Objective To study the anesthesia blockade effect of bupivacaine hydrochloride mixture with different specific gravities on lower abdominal and lower limb surgery under combined spinal-epidural anesthesia and its influence on limb hallucination. Methods A total of 192 patients with ASA grade I-II scheduled for lower abdominal and lower limb surgery under combined spinal-epidural anesthesia were retrospectively selected and divided into group A(subarachnoid block anesthesia with low-specific-gravity bupivacaine hydrochloride mixed solution, n =68) and group B(subarachnoid block anesthesia with high-specificgravity bupivacaine hydrochloride mixed solution, n =124) according to the different specific gravities of bupivacaine hydrochloride mixed solutions. Hemodynamics, anesthesia blocking effect, limb hallucination and adverse reactions during anesthesia were observed between the two groups. Results The MBP five minutes after subarachnoid block in group A was significantly lower than that five minutes after the patients entered the room(P < 0.05); the MBP and HR five minutes after subarachnoid block in group B were significantly lower tha n those of group A and those five minute s after the patients of the same group entered the room( P < 0.05).There was no statistical difference at the other time points between t he two groups(P > 0.05). After anesthesia, the onset time of sensory block and the time of reaching the highest level of sensory block in group A were longer than those in group B, and the duration of motor and sensory nerve block was shorter than that in group B(P < 0.05). There was no limb hallucination in group A but 124 cases(71.77%) in group B. Conclusion Compared with high-specific-gravity bupivacaine hydrochloride, low-specific-gravity bupivacaine hydrochloride has less hemodynamic impact on patients undergoing lower abdominal surgery and lower limb surgery under combined spinal-epidural anesthesia. The incidence of adverse reactions is low, and there is no limb hallucination, so it is safer in application.
Objective To study the anesthesia blockade effect of bupivacaine hydrochloride mixture with different specific gravities on lower abdominal and lower limb surgery under combined spinal-epidural anesthesia and its influence on limb hallucination. Methods A total of 192 patients with ASA grade I-II scheduled for lower abdominal and lower limb surgery under combined spinal-epidural anesthesia were retrospectively selected and divided into group A(subarachnoid block anesthesia with low-specific-gravity bupivacaine hydrochloride mixed solution, n =68) and group B(subarachnoid block anesthesia with high-specificgravity bupivacaine hydrochloride mixed solution, n =124) according to the different specific gravities of bupivacaine hydrochloride mixed solutions. Hemodynamics, anesthesia blocking effect, limb hallucination and adverse reactions during anesthesia were observed between the two groups. Results The MBP five minutes after subarachnoid block in group A was significantly lower than that five minutes after the patients entered the room(P < 0.05); the MBP and HR five minutes after subarachnoid block in group B were significantly lower tha n those of group A and those five minute s after the patients of the same group entered the room( P < 0.05).There was no statistical difference at the other time points between t he two groups(P > 0.05). After anesthesia, the onset time of sensory block and the time of reaching the highest level of sensory block in group A were longer than those in group B, and the duration of motor and sensory nerve block was shorter than that in group B(P < 0.05). There was no limb hallucination in group A but 124 cases(71.77%) in group B. Conclusion Compared with high-specific-gravity bupivacaine hydrochloride, low-specific-gravity bupivacaine hydrochloride has less hemodynamic impact on patients undergoing lower abdominal surgery and lower limb surgery under combined spinal-epidural anesthesia. The incidence of adverse reactions is low, and there is no limb hallucination, so it is safer in application.
引文
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[2]翟书涛.体象障碍[J].四川精神卫生,1996,9(3):211-212,214.
[3]于建华,张铁良.脊髓损伤后的肢体幻像现象[J].中华骨科杂志,1999,19(4):11-12.
[4]姬银明,杜军旺,宁养红,等.重比重与等比重盐酸布比卡因在临床腰麻应用中的研究[J].中国实用医药,2009,4(23):160-162.
[5] Farmer KL, Li CY, Dobrowsky RT. Diabetic peripheral neuropathy:shoulda chaperone accompany our therapeutic approach[J]. Pharmacol Rev, 2012, 64(4):880-900.
[6] Zuliani G, Galvani M, Maggion M, et al. Plasma soluble gp130levels are increased in older subjects with metabolic syndrome:the role of insulin resistance[J]. Atherosclerosis, 2010, 213(1):319-324.