三种不同局麻药腰硬联合麻醉在TVP中应用效果比较.doc

三种不同局麻药腰硬联合麻醉在TVP中应用效果比较 　作者：邵雪泉 殷萍 程李健 徐玲 童炎岳 万里军 【摘要】 ［目的］比较三种不同局麻药腰硬联合麻醉(CSEA)用于经尿道前列腺汽化电切术(TVP)患者的安全性和有效性。［方法］选择良性前列腺增生老年患者90例，在CSEA下实施TVP手术。按所用局麻药随机均分为三组，Ⅰ组左旋布比卡因15mg；Ⅱ组罗哌卡因15mg；Ⅲ组布比卡因15mg。比较三组感觉、运动阻滞及恢复的异同，并观察用药后的不良反应。［结果］三组患者麻醉镇痛优良率达100%，但罗哌卡因的镇痛起效时间、运动阻滞起效时间、最大阻滞时间、最大运动阻滞时间比左旋布卡因和布比卡因显著延长(Plt;0.05或Plt;0.01)；麻醉持续时间、痛觉恢复时间、运动恢复时间比左旋布比卡因和布比卡因显著缩短(Plt;0.05或Plt;0.01)；罗哌卡因最大Bromage评分明显优于左旋布卡因和布比卡因(Plt;0.01)。［结论］等比重小剂量罗哌卡因CSEA用于老年患者TVP手术是安全有效的，且不良反应少。 【关键词】 左旋布比卡因；罗哌卡因；布比卡因；腰硬联合麻醉；经尿道前列腺汽化电切术 　　Abstract:［Objective］ To compare the effect and safety of 3 different local anesthetics for combined spinalepidural anesthesia (CSEA) on transurethral electrovapor resection of prostate (TVP). ［Methods］ 90 cases, schedule for TVP in CSEA, were randomly divided into 3 groups according to different local anesthetics. Group Ⅰlevobupivacaine；group Ⅱropivacaine；group Ⅲ bupivacaine. Compare the similarities and differences of 3 groups feeling, movement and restore from block, and observe the adverse reactions. ［Results］ Narcotic analgesic excellent rates of 3 groups were 100%, but the analgesic onset time, the sports block onset time, the largest block of time, the largest sports block of time were significantly longer in ropivacaine group than those in levobupivacaine and bupivacaine groups；Duration of anesthesia, pain recovery time, sports block recovery time in group Ⅱwere significantly shorter than those in groupⅠand group Ⅲ；The largest Bromage score in group ropivacaine was superior than that in group levobupivacaine and group bupivacaine.［Conclusion］Lowdose and isobaric ropivacaine for CSEA in elderly on TVP is safe and effective, with less adverse reactions. 　　Key words: Levobupivacaine；Ropivacaine；Bupivacaine；combined spinalepidural anesthesia；transurethral eletrovapor resection of the prostate 新型长效局麻药左旋布比卡因、罗哌卡因及布比卡因临床上广泛用于硬膜外麻醉、神经阻滞及术后硬膜外镇痛等。应用于蛛网膜下隙阻滞尚少见报道。本研究拟比较三种不同局麻药腰硬联合麻醉(CSEA)用于经尿道前列腺汽化电切术(TVP)患者的镇痛效应及可行性，旨为临床应用提供参考。 　　1 资料与方法 　　1.1 一般资料 　　90例前列腺增生老年患者，AS