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目的观察模拟舰船摇摆状态对0.75%罗哌卡因蛛网膜下腔阻滞的影响。方法40例择期下腹部及下肢手术患者随机分成两组:水平对照组(n=20),蛛网膜下腔注药后患者由侧卧位改仰卧位,手术床始终置水平位。模拟摇摆组(n=20),蛛网膜下腔注药后患者由侧卧位改仰卧位,随即将手术床按顺序进行模拟摇摆共30 m in。蛛网膜下腔用药均为0.75%罗哌卡因原液3 m l,注药速度为1 m l/5 s。比较观察两组患者的感觉、运动阻滞平面、作用起效和持续时间、血流动力学变化及相关的副反应。结果两组患者的一般资料、血流动力学指标、麻醉相关副反应等均无差异(P>0.05);两组之间的感觉阻滞起效时间、向尾延伸时间及持续总时间、运动阻滞起效和持续时间、达最大运动阻滞时间也无统计学差异(P>0.05)。摇摆组感觉阻滞向头延伸时间(16.3±3.0)m in,明显长于对照组(12.9±2.6)m in,阻滞平面固定后摇摆组的感觉减退和消失平面均经对照组高2个节段左右(P<0.01)。结论0.75%罗哌卡因用于模拟舰船摇摆状态下蛛网膜下腔阻滞,其血流动力学平稳,副反应少。但阻滞平面固定时间稍延长,阻滞平面稍升高,故应相应调整注药剂量。
Objective To observe the effect of simulated wobbling state on subarachnoid block of 0.75% ropivacaine. Methods Forty patients undergoing lower abdominal and lower limb surgery were randomly divided into two groups: control group (n = 20). After subarachnoid injection, the patients were placed in supine position with lateral position and the operating table was always horizontal. The simulated swing group (n = 20), subarachnoid injection of patients from the lateral position to supine position, then the operating bed in order to simulate the swing a total of 30 m in. Subarachnoid drugs were 0.75% ropivacaine stock solution 3 ml, injection speed of 1 m l / 5 s. The sensory, locomotor blockage, onset and duration of action, hemodynamic changes, and associated side effects were compared between the two groups. Results There was no difference in general data, hemodynamic parameters and side effects of anesthesia between the two groups (P> 0.05). The onset time, the extension to the tail and the total duration of the sensory block between the two groups, There was no significant difference in the onset and duration of arrest and the maximum block time (P> 0.05). In the swing group, the sensory block to head extension time was (16.3 ± 3.0) m in, which was significantly longer than that in the control group (12.9 ± 2.6) m in. The sensory loss and disappearance plane in the swing group were significantly higher than those in the control group (P <0.01). Conclusions 0.75% ropivacaine is used to simulate subarachnoid block in the wobble of a ship, with a steady hemodynamics and few side effects. However, a little prolonged block plane fixation, block slightly increased plane, it should be adjusted accordingly injection dose.