不同浓度葡萄糖复合罗哌卡因用于老年患者腰麻的效果
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摘要
目的：观察0.67%的罗哌卡因复合不同浓度葡萄糖用于中老年患者的腰麻效果比较。
方法：选择年龄65-80岁ASA分级Ⅰ-Ⅱ级行择期单侧大隐静脉曲张高位结扎分段剥脱术的中老年患者80名，随机分为四组每组20例：5%葡萄糖组（A组）,10%葡萄糖组（B组）,25%葡萄糖组（C组）,50%葡萄糖组（D组）。所有患者患侧卧位，选择L3-4腰椎间隙进行穿刺。观察四组感觉运动神经阻滞情况,血液动力学变化麻醉效果以及不良反应。术中监测生命体征,术后随访并发症。
结果：D组感觉运动阻滞起效时间明显比A.B.C组时间短(P <0.05),痛觉阻滞,运动阻滞持续时间明显比A.B.C组长(P <0.05)，但是C组腰麻阻滞平面较D组更加缓慢稳定。四组不良反应发生率都很低,差异无统计学意义(P>0.05),四组血液动力学变化差异无统计学意义(P>0.05)，四组中均无麻醉失败患者。
结论：用0.67%罗哌卡因复合25%葡萄糖腰麻时，其起效时间，痛觉和运动阻滞时间效果虽不及50%葡萄糖组但是25%葡萄糖组腰麻阻滞平面较50%葡萄糖组更加缓慢稳定。四组血液动力学变化影响都较小，并发症的发生率四组相比亦无统计学差异，因此综合考虑0.67%罗哌卡因复合25%葡萄糖可以更加安全的用于中老年患者蛛网膜下腔阻滞。
Objective：To observe the effect of0.67%ropivacaine combined differ-ent concentration of glucose on the aged patients underwent lumbar anesthesia.
Methods：Eighty patients undergoing unilateral high ligation segmentationstripping of great saphenous varicose vein surgical procedures， aged from65～80years old，were randomly allocated to5%，10%，25%and50%glucose groups. All patients were affected lateral decubitus position. Lumbarspace of L3～4was selected to puncture. The sensorimotor nerve block，hemodynamics change and adverse reaction were observed. Vital signs of thepatients during operation were monitored. The patients were followed up afteroperation to record complications related anesthesia.
Results： Onset of sensorimotor block in50%glucose group was shorterthan that of the other three groups (P＜0.05)， algesia and motor blockduration in50%glucose group was longer than that of the other three groups(P＜0.05). But lumbar anesthesia block plane of25%glucose group wasmore stable than that of50%glucose group. There were very low incidences ofadverse reaction of the four groups without significant difference (P＞0.05).Four groups had no significant difference in hemodynamics changes (P＞0.05) and no anesthesia failure.
Conclusions：0.67%ropivacaine combined25%glucose could safelyused in the aged patients with subarachnoid block.
方法：选择年龄65-80岁ASA分级Ⅰ-Ⅱ级行择期单侧大隐静脉曲张高位结扎分段剥脱术的中老年患者80名，随机分为四组每组20例：5%葡萄糖组（A组）,10%葡萄糖组（B组）,25%葡萄糖组（C组）,50%葡萄糖组（D组）。所有患者患侧卧位，选择L3-4腰椎间隙进行穿刺。观察四组感觉运动神经阻滞情况,血液动力学变化麻醉效果以及不良反应。术中监测生命体征,术后随访并发症。
结果：D组感觉运动阻滞起效时间明显比A.B.C组时间短(P <0.05),痛觉阻滞,运动阻滞持续时间明显比A.B.C组长(P <0.05)，但是C组腰麻阻滞平面较D组更加缓慢稳定。四组不良反应发生率都很低,差异无统计学意义(P>0.05),四组血液动力学变化差异无统计学意义(P>0.05)，四组中均无麻醉失败患者。
结论：用0.67%罗哌卡因复合25%葡萄糖腰麻时，其起效时间，痛觉和运动阻滞时间效果虽不及50%葡萄糖组但是25%葡萄糖组腰麻阻滞平面较50%葡萄糖组更加缓慢稳定。四组血液动力学变化影响都较小，并发症的发生率四组相比亦无统计学差异，因此综合考虑0.67%罗哌卡因复合25%葡萄糖可以更加安全的用于中老年患者蛛网膜下腔阻滞。
Objective：To observe the effect of0.67%ropivacaine combined differ-ent concentration of glucose on the aged patients underwent lumbar anesthesia.
Methods：Eighty patients undergoing unilateral high ligation segmentationstripping of great saphenous varicose vein surgical procedures， aged from65～80years old，were randomly allocated to5%，10%，25%and50%glucose groups. All patients were affected lateral decubitus position. Lumbarspace of L3～4was selected to puncture. The sensorimotor nerve block，hemodynamics change and adverse reaction were observed. Vital signs of thepatients during operation were monitored. The patients were followed up afteroperation to record complications related anesthesia.
Results： Onset of sensorimotor block in50%glucose group was shorterthan that of the other three groups (P＜0.05)， algesia and motor blockduration in50%glucose group was longer than that of the other three groups(P＜0.05). But lumbar anesthesia block plane of25%glucose group wasmore stable than that of50%glucose group. There were very low incidences ofadverse reaction of the four groups without significant difference (P＞0.05).Four groups had no significant difference in hemodynamics changes (P＞0.05) and no anesthesia failure.
Conclusions：0.67%ropivacaine combined25%glucose could safelyused in the aged patients with subarachnoid block.
引文
[1] Svensson LG，Klepp P，Hinder RA. Spinal cord anesthesia of the babooncomparison with man and implications of spinal cord blood flow duringthoracic aortic cross-clamping[J]. A Afr J Surg，1986，24:32-4.
[2] Kleef JW, Veering BT, Bu rm AG Spinal anes thesia w ith rop ivacaine: adoub leblind study on the ef ficacy and safety of0.5%and0.75%solut ions in patients undergo ing m inor low er limb surgery[J]. An esth Analg,1994,78(6):1125-1130
[3] Kristen sen JD, K arlsten R, Gordh T Spin al cord blood flow after in trathecal inject ion of rop ivacaine: a screen ig for neurotoxic effects[J]. AnesthAn alg,1996,82(3):636-640
[4] Kristensen JD, KarlstenR, Gordh T Spinal cord blood flow afterintrathecalin jection of rop ivaca ine and bup iva cain e w ith or w ithout epinephrinein rats [J]. Acta Anaesthesio l S cand,1998,42(6):685-690
[5]郭艳辉,王俊科罗哌卡因用于蛛网膜下腔阻滞的实验研究[J].中华麻醉学杂志,2002,22(1):42-45
[6]孙志华,郭曲练,邹望远间断鞘内注射不同浓度罗哌卡因对大鼠脊髓及神经根早期超微结构的影响[J].中华麻醉学杂志,2005,4(25):283-286
[7]杨胜辉,郭曲练,王懿春,等间断鞘内注射罗哌卡因后大鼠血清髓磷脂碱性蛋白变化与脊髓超微结构改变[J].中南大学学报(医学版),2008,33(6):527–532
[8]陈朝辉,高勤,刘洋,万勇,陈斌,孙桂英等不同浓度罗哌卡因等比重腰麻在前列腺等离子电切术中的应用效果比较[J].川北医学院学报，2010,25（3）：259-261:
[9]彭沛华,陈燕,衡新华,等不同浓度罗哌卡因用于老年患者腰硬联合麻醉的临床观察[J].中国现代医生,2009,47(1):7-8
[10]王伟芝，张彩云，刘振海.腰-硬联合麻醉致脊髓栓系病人截瘫的临床分析[J].临床麻醉学杂志，2008，24：731.
[11]庾俊雄，不同比重罗哌卡因腰麻用于剖宫产术的评价[J].华夏医学，2003,16（3）：328-329
[12]Wabedi W, Nolte H. Ropivacain e f or s pinal anes thes ia, adosef indingstudy[J]. Anaesthesist,1996,45:737-744.
[13]徐莉，等.剖宫产手术腰麻中腰麻液比重的影响[J].实用预防医学，2006，13（2）：386-387.
[14]严爵基，陈世鸿，陈灿，李镇维，不同罗哌卡因腰麻注药时间对循环和麻醉效果的影响[J].广西医学，2010,32（7）：801-803
[15]Hashimoto K, Sakura S, Boll en AW, et al. Comparative t oxicity ofglucoseand lidocaine administered intrathecally in the rat [J]. Reg AnesthPain Med,1998,23(5):444450.
[16]张研,胡允梅,田荣,郭莉芳,葡萄糖对罗哌卡因蛛网膜下腔阻滞的影响[J]新乡医学院学报，2008,25（6）:577-588
[17]Kooger In fante NE, Van GesselE, Forster A, et al. Exten t of hyperbaric spinal anesth es ia in fluen ces the du ration of spinal block [J].A nesthesio-logy,2000,92(6):1319-1323.
[18]管淑玲，苏振波，辛敏刚，赵国庆，魏忠海，布比卡因-高渗葡萄糖混合溶液在硬膜外麻醉中的应用[J].江苏医药，2006，32（11）：1094
[19]杨寒星,曹经山硬膜外高渗糖-布比卡因与吗啡用于术后镇痛的比较观察临床麻醉学杂志,1996,12:219
[20]邹时宏,李圣平,甘孝红.高渗糖-布比卡因用于硬膜外术后镇痛的临床观察.医学理论与实践,2003,16:800
[21]Kytta J Com pari son betw een0.5%bupivacaine w ith and without glucose in lumbar epidu ral b lock f or k nee surgery. Act aAnaes thesi ol S can d,1987,31:305-308.
[22]易杰，黄宇光，罗爱伦.罗哌卡因用于腰麻-硬膜外联合阻滞的临床观察[J].中华麻醉学杂志，2000，20(1):26-8.
[23]李淑华，陈丽，李秋茹.比重不同的布比卡因在腰麻中的临床研究〔J〕.青海医药杂志，2002,32(2):41-2.
[24]Ganem EM，Vianna PT，Marques M， et al. Neurotoxicity of subarachnoidhyperbaric bupivacaine in dogs[J]. Reg Anesth，1997,22(2):198-9.
[25]Sakura S，Chan VW，Ciriales R， et al. The addition of7.5%glucose doesnot alter the neurotoxicity of5%lidocaine administered intrathecally in therat[J]. Anesthesiology，1995,82(1):236-40.
[26]Hashimoto K，Sakura S，Bollen AW， et al. Comparative toxicity ofglucose and lidocaine administered intrathecally in the rat[J]. Reg AnesthPain Med，1998,23(5):444-50.
[27]赵勇东.8000例蛛网膜下腔注入罗哌卡因对剖宫产患者神经毒性的回顾综述[C].2009年西部麻醉学术论坛论文汇编，2009,394-5.
[28]胡雁东，郭建林，尚扁吾.16.67%葡萄糖和0.5%布比卡因用于蛛网膜下隙阻滞术924例分析[J].临床医药实践杂志，2002;11(12):903-4.
[29]马烈，刘俊杰.椎管内麻醉的意外及并发症.见:刘俊杰，赵俊.现代麻醉学[M].第2版.北京:人民卫生出版社，1997:645-7.
[30]王玥.罗哌卡因重比重腰硬联合麻醉及术后镇痛致短暂性神经综合征二例[J].临床麻醉学杂志，2007,23(10):826.
[31]辛忠，朱慧英.蛛网膜下腔阻滞麻醉并发暂时性神经症状.国外医学·麻醉与复苏分册，2000,21(5):299-301.
[32]从寿耆，赵俊.局麻药的神经毒性[J].国外医学·麻醉与复苏分册，2000,21(5):291-2.
[33]Kallio H，Snall EVT，Kero MP， et al. A comparison of intrathecal plainsolutions containing ropivacaine20or15mg versus bupivacaine10mg.Anesth Analg，2004,99(3):713-7.
[34]庄心良，曾因明，陈伯銮.现代麻醉学[M].第3版.北京:人民卫生出版社，2003,1081-2.
[2] Kleef JW, Veering BT, Bu rm AG Spinal anes thesia w ith rop ivacaine: adoub leblind study on the ef ficacy and safety of0.5%and0.75%solut ions in patients undergo ing m inor low er limb surgery[J]. An esth Analg,1994,78(6):1125-1130
[3] Kristen sen JD, K arlsten R, Gordh T Spin al cord blood flow after in trathecal inject ion of rop ivacaine: a screen ig for neurotoxic effects[J]. AnesthAn alg,1996,82(3):636-640
[4] Kristensen JD, KarlstenR, Gordh T Spinal cord blood flow afterintrathecalin jection of rop ivaca ine and bup iva cain e w ith or w ithout epinephrinein rats [J]. Acta Anaesthesio l S cand,1998,42(6):685-690
[5]郭艳辉,王俊科罗哌卡因用于蛛网膜下腔阻滞的实验研究[J].中华麻醉学杂志,2002,22(1):42-45
[6]孙志华,郭曲练,邹望远间断鞘内注射不同浓度罗哌卡因对大鼠脊髓及神经根早期超微结构的影响[J].中华麻醉学杂志,2005,4(25):283-286
[7]杨胜辉,郭曲练,王懿春,等间断鞘内注射罗哌卡因后大鼠血清髓磷脂碱性蛋白变化与脊髓超微结构改变[J].中南大学学报(医学版),2008,33(6):527–532
[8]陈朝辉,高勤,刘洋,万勇,陈斌,孙桂英等不同浓度罗哌卡因等比重腰麻在前列腺等离子电切术中的应用效果比较[J].川北医学院学报，2010,25（3）：259-261:
[9]彭沛华,陈燕,衡新华,等不同浓度罗哌卡因用于老年患者腰硬联合麻醉的临床观察[J].中国现代医生,2009,47(1):7-8
[10]王伟芝，张彩云，刘振海.腰-硬联合麻醉致脊髓栓系病人截瘫的临床分析[J].临床麻醉学杂志，2008，24：731.
[11]庾俊雄，不同比重罗哌卡因腰麻用于剖宫产术的评价[J].华夏医学，2003,16（3）：328-329
[12]Wabedi W, Nolte H. Ropivacain e f or s pinal anes thes ia, adosef indingstudy[J]. Anaesthesist,1996,45:737-744.
[13]徐莉，等.剖宫产手术腰麻中腰麻液比重的影响[J].实用预防医学，2006，13（2）：386-387.
[14]严爵基，陈世鸿，陈灿，李镇维，不同罗哌卡因腰麻注药时间对循环和麻醉效果的影响[J].广西医学，2010,32（7）：801-803
[15]Hashimoto K, Sakura S, Boll en AW, et al. Comparative t oxicity ofglucoseand lidocaine administered intrathecally in the rat [J]. Reg AnesthPain Med,1998,23(5):444450.
[16]张研,胡允梅,田荣,郭莉芳,葡萄糖对罗哌卡因蛛网膜下腔阻滞的影响[J]新乡医学院学报，2008,25（6）:577-588
[17]Kooger In fante NE, Van GesselE, Forster A, et al. Exten t of hyperbaric spinal anesth es ia in fluen ces the du ration of spinal block [J].A nesthesio-logy,2000,92(6):1319-1323.
[18]管淑玲，苏振波，辛敏刚，赵国庆，魏忠海，布比卡因-高渗葡萄糖混合溶液在硬膜外麻醉中的应用[J].江苏医药，2006，32（11）：1094
[19]杨寒星,曹经山硬膜外高渗糖-布比卡因与吗啡用于术后镇痛的比较观察临床麻醉学杂志,1996,12:219
[20]邹时宏,李圣平,甘孝红.高渗糖-布比卡因用于硬膜外术后镇痛的临床观察.医学理论与实践,2003,16:800
[21]Kytta J Com pari son betw een0.5%bupivacaine w ith and without glucose in lumbar epidu ral b lock f or k nee surgery. Act aAnaes thesi ol S can d,1987,31:305-308.
[22]易杰，黄宇光，罗爱伦.罗哌卡因用于腰麻-硬膜外联合阻滞的临床观察[J].中华麻醉学杂志，2000，20(1):26-8.
[23]李淑华，陈丽，李秋茹.比重不同的布比卡因在腰麻中的临床研究〔J〕.青海医药杂志，2002,32(2):41-2.
[24]Ganem EM，Vianna PT，Marques M， et al. Neurotoxicity of subarachnoidhyperbaric bupivacaine in dogs[J]. Reg Anesth，1997,22(2):198-9.
[25]Sakura S，Chan VW，Ciriales R， et al. The addition of7.5%glucose doesnot alter the neurotoxicity of5%lidocaine administered intrathecally in therat[J]. Anesthesiology，1995,82(1):236-40.
[26]Hashimoto K，Sakura S，Bollen AW， et al. Comparative toxicity ofglucose and lidocaine administered intrathecally in the rat[J]. Reg AnesthPain Med，1998,23(5):444-50.
[27]赵勇东.8000例蛛网膜下腔注入罗哌卡因对剖宫产患者神经毒性的回顾综述[C].2009年西部麻醉学术论坛论文汇编，2009,394-5.
[28]胡雁东，郭建林，尚扁吾.16.67%葡萄糖和0.5%布比卡因用于蛛网膜下隙阻滞术924例分析[J].临床医药实践杂志，2002;11(12):903-4.
[29]马烈，刘俊杰.椎管内麻醉的意外及并发症.见:刘俊杰，赵俊.现代麻醉学[M].第2版.北京:人民卫生出版社，1997:645-7.
[30]王玥.罗哌卡因重比重腰硬联合麻醉及术后镇痛致短暂性神经综合征二例[J].临床麻醉学杂志，2007,23(10):826.
[31]辛忠，朱慧英.蛛网膜下腔阻滞麻醉并发暂时性神经症状.国外医学·麻醉与复苏分册，2000,21(5):299-301.
[32]从寿耆，赵俊.局麻药的神经毒性[J].国外医学·麻醉与复苏分册，2000,21(5):291-2.
[33]Kallio H，Snall EVT，Kero MP， et al. A comparison of intrathecal plainsolutions containing ropivacaine20or15mg versus bupivacaine10mg.Anesth Analg，2004,99(3):713-7.
[34]庄心良，曾因明，陈伯銮.现代麻醉学[M].第3版.北京:人民卫生出版社，2003,1081-2.