| 阙红波,史青梅,王守义,魏大明,李元海.不同剂量阿芬太尼复合罗哌卡因椎管内麻醉对肛肠手术术中及术后尿潴留的影响[J].,2022,(5):886-890 |
| 不同剂量阿芬太尼复合罗哌卡因椎管内麻醉对肛肠手术术中及术后尿潴留的影响 |
| Effect of Different Doses of Intrathecal Anesthesia with Anfentanil Eombined with Ropivacaine on Postoperative Urinary Retention in Anorectal Surgery |
| 投稿时间：2021-06-23 修订日期：2021-07-18 |
| DOI：10.13241/j.cnki.pmb.2022.05.018 |
| 中文关键词: 阿芬太尼 罗哌卡因 椎管内麻醉 肛肠手术 尿潴留 应激反应 |
| 英文关键词: Alfentanil Ropivacaine Spinal anesthesia Anorectal surgery Urinary retention Stress response |
| 基金项目:安徽省普通高校重点实验室项目（MZKF202002） |
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| 中文摘要: |
| 摘要 目的：探讨不同剂量阿芬太尼复合罗哌卡因椎管内麻醉对肛肠手术术中及术后尿潴留的影响。方法：选取我院2020年4月到2020年12月共收治的100例肛肠手术患者作为研究对象，将患者随机分为A组、B组和C组，A组30例，B组30例，C组40例。所有患者均行阿芬太尼复合罗哌卡因椎管内腰硬联合麻醉，其中A组患者阿芬太尼剂量为1 μg/kg，B组为5 μg/kg，C组为10 μg/kg，对比三组患者麻醉效果，对比三组患者麻醉前、麻醉后、手术1 h后的平均动脉压（MAP）、心率（HR）、心脏指数（CI）、每搏指数（SVI）和每搏变异度（SVV）变化情况，术后1 h、术后2 h、术后3 h和术后6 h的VAS评分以及术后不良反应和尿潴留发生率。结果：通过对比三组患者麻醉效果发现，A组患者优良率为80.00%，B组患者优良率为100.00%，C组患者优良率为100.00%，C组高于A组和B组（P＜0.05）；麻醉前三组患者的SVV、SVI、CI、MAP、HR对比无明显差异（P＞0.05），麻醉后三组患者SVV、CI对比无明显差异（P＞0.05），但三组患者的SVI、MAP、HR对比差异显著，C组明显高于A组和B组（P＜0.05），手术1 h后，三组患者的SVV、SVI对比无明显差异（P＞0.05），但两者CI、MAP、HR对比差异显著，C组高于于A组和B组（P＜0.05）；通过对比三组患者术后不同时间VAS评分发现，三组患者术后6 h的 VAS评分对比无明显差异（P＞0.05），术后1 h、术后2 h、术后3 h三组患者VAS评分对比差异显著，C组明显低于A组和B组；C组患者嗜睡、恶心呕吐、肛门下坠感等术后不良反应对比无明显差异（P＞0.05），C组患者术后尿潴留发生率明显低于B组和A组，组间对比，差异具有统计学意义（P＜0.05）。结论：5 μg/kg与10 μg/kg阿芬太尼复合罗哌卡因椎管内麻醉对肛肠手术患者均具有非常好的麻醉效果，但是应用剂量为10 μg/kg阿芬太尼符合罗哌卡因能够稳定患者血流动力学指标，降低患者应激反应，而且术后具有一定的阵痛效果，安全性好，且能够减少患者术后尿储留的发生情况，值得临床应用推广。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effect of different doses of intrathecal anesthesia with anfentanil combined with ropivacaine on postoperative urinary retention in anorectal surgery. Methods: 100 patients with anorectal surgery in our hospital from April 2020 to December 2020 were randomly divided into group A, group B and group C, 30 cases in group A, 30 cases in group B and 40 cases in group C. All patients received combined spinal epidural anesthesia with alfentanil and ropivacaine, and the dose of alfentanil in group A was 1 μG/kg, group B was 5 μG/kg, group C was 10 μG/kg, the anesthetic effect of the three groups was compared. The mean arterial pressure (MAP), heart rate (HR), heart index (CI), stroke index (SVI) and stroke variability (SVV) were compared between the three groups before anesthesia, after anesthesia and 1 h after operation. The 1 h, postoperative 2 h, postoperative 3H and postoperative 6 h score and postoperative adverse reactions and urinary retention rates were compared. Results: The excellent and good rate of group A was 80.00%, that of group B was 100.00%, that of group C was 100.00%, and that of group C was higher than that of group A and group B(P<0.05); There was no significant difference in SVV, SVI, CI, map and HR among the three groups before anesthesia(P>0.05), and there was no significant difference in SVV and CI among the three groups after anesthesia(P>0.05), but there was significant difference in SVI, map and HR among the three groups. Group C was significantly higher than group A and group B(P<0.05). There was no significant difference in SVV and SVI among the three groups one hour after operation(P>0.05), but there was no significant difference in CI, map and HR among the three groups The HR of group C was higher than that of group A and group B(P<0.05); By comparing the VAS scores of the three groups at different time after operation, it was found that there was no significant difference in the VAS scores of the three groups at 6 h after operation(P>0.05), but there was significant difference in the VAS scores of the three groups at 1 h, 2 h and 3 h after operation, and the VAS scores of group C were significantly lower than those of group A and group B; There was no significant difference in postoperative adverse reactions between patients in group C, such as drowsiness, nausea and vomiting, and anal drop sensation (P>0.05). The incidence of postoperative urinary retention in group C was significantly lower than that in group B and A, and the difference between groups was statistically significant(P＞0.05). Conclusion: 5 μg/kg and 10 μg/kg alfentanil combined with ropivacaine intraspinal anesthesia has a very good anesthetic effect on anorectal surgery patients, but the application dose is 10 μg/kg alfentanil in line with ropivacaine can stabilize the hemodynamics of patients, reduce the stress response of patients, and has a certain pain effect after operation, good safety, and can reduce the occurrence of postoperative urinary retention, which is worthy of clinical application and promotion. |
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