不同浓度布比卡因腰麻联合B超指导限制性输液策略在下肢小手术中的应用

Application of Different Concentration Bupivacaine in Spinal Anesthesia Combined with Ultrasound Guided Limited Infusion Strategy in Lower Extremity Surgery

摘要: 目的：探索不同浓度布比卡因腰麻，联合B超监测限制性输液策略，在下肢短小手术中应用，为单次腰麻合理用于下肢短小手术快速康复提供依据。方法：选择腰麻下择期行下肢短小手术患者(ASAI-II) 90例，腰麻用药为布比卡因7.5 mg，根据浓度不同，随机分为3组：0.25组(0.25%, 3 ml)、0.375组(0.375%, 2 ml)，0.5组(0.5%, 1.5 ml)。测定并记录感觉、运动阻滞及恢复情况；术中及术后B超测量膀胱体积指导液体，记录导尿或留置尿管情况。结果：0.25组与0.5组相比，感觉平面达T10起效时间(min)明显缩短(P < 0.05)，最大感觉阻滞平面明显升高(P < 0.05)；感觉阻滞恢复时间三组没有明显差异(P > 0.05)。低浓度组达到最大运动阻滞时间(改良Bromage法)明显延长(P < 0.01)；运动阻滞恢复时间显著缩短(P < 0.01)。0.25组与0.375组、0.5组比较，术后第一次自主排尿时间明显缩短(P < 0.05, P < 0.01)。结论：不同浓度布比卡因(7.5 mg)腰麻，同时联合B超指导下限制性输液策略，均使术后尿潴留发生率显著降低；低浓度组运动阻滞、自主排尿恢复更快；利于下肢短小手术快速康复。

Abstract: Objective: To study the effect of different concentrations bupivacaine on spinal anesthesia, for rapid rehabilitation of lower limbs. Methods: 90 ASA I-II younger patients (18 - 65 years) undergoing lower limb surgery, according to different concentrations of bupivacaine (7.5mg) were randomly divided into 3 groups: group 0.25 (0.25%, 3 ml), group 0.375 (0.375%, 2 ml), group 0.5 (0.5%, 1.5 ml). The sensory, motor block and recovery were measured and recorded. B ultrasonic measurements of bladder volume were used to guide fluid therapy and bladder catheterization was determined according to bladder filling. Results: The 0.25 group was compared with the 0.5 group; the sensory level reached T10 onset time (min) was significantly shortened (P < 0.05); the maximum level of sensory block was significantly higher (P < 0.05); the recovery of sensory of the three groups has no obvious difference (P > 0.05). With bupivacaine concentration decreased between groups, the maximum motor block time (improved Bromage scale) was significantly prolonged (P < 0.01); motor block recovery time was significantly shortened (P < 0.01). Compared with the 0.375 group and the 0.5 group, the first independent micturition time was obviously shortened in the 0.25 group (P < 0.05, P < 0.01). Conclusion: Different concentrations of bupivacaine (7.5 mg) spinal anesthesia, combined with B-ultrasound guided restrictive infusion strategy, significantly reduced the incidence of postoperative urinary retention; 0.25 group has spontaneous urinary and motor block recovery faster for the lower limbs short surgery.