CAJ | 학술논문

目的研究腹股沟斜疝修补术中蛛网膜下隙阻滞（腰麻）配制液中芬太尼最佳配制剂量。方法择期行腹股沟斜疝手术患者100例，ASA分级Ⅰ～Ⅱ级。按随机数字表法分为五组，每组20例。腰麻配制液：B组：0.75％布比卡因2 ml+ 0.9％氯化钠1.0 ml；BF5组：0.75％布比卡因2ml+50 μ g/ml芬太尼0.1 ml+ 0.9％氯化钠0.9 ml;BF10组：0.75％布比卡因2ml+50 μg/ml芬太尼0.2 ml+ 0.9％氯化钠0.8 ml; BF20组：0.75％布比卡因2ml+ 50μg/ml芬太尼0.4 ml+ 0.9％氯化钠0.6 ml; BF30组：0.75％布比卡因2ml+ 50μ g/ml芬太尼0.6 ml+ 0.9％氯化钠0.4 ml。患者取左侧卧位，选L2～3间隙穿刺，各组分别推注腰麻配制液3ml。测量并记录达到最高阻滞平面时间、感觉平面退到T12平面时间、运动恢复时间、麻醉效果、镇痛维持时间、手术时间及不良反应。结果BF30组达到最高阻滞平面时间较B组、BF5组、BF10组、BF20组短(P＜0.05)，而B组和BF5组较BF10组、BF20组、BF30组长(P＜0.05)。BF20组感觉平面退到T12平面时间较B组、BF5组、BF10组、BF30组长（P＜0.05），B组和BF5组较BF10组、BF20组、BF30组短(P＜0.05)。B组和BF5组运动恢复时间和镇痛维持时间较BF10组、BF20组、BF30组短(P＜0.05)。B组患者发生瘙痒例数(0)明显少于BF5组（8例）、BF10组（3例）、BF20组（6例）、BF30组（6例）（P＜0.05）。所有患者均未发生呼吸抑制。结论在0.75％布比卡因腰麻配制液中加入10 μg芬太尼可以缩短达到最高阻滞平面时间，感觉及运动恢复时间与镇痛维持时间也相应延长，在30μg内这种效应并不存在剂量依赖性。
목적연구복고구사산수보술중주망막하극조체（요마）배제액중분태니최가배제제량。방법택기행복고구사산수술환자100례，ASA분급Ⅰ～Ⅱ급。안수궤수자표법분위오조，매조20례。요마배제액：B조：0.75％포비잡인2 ml+ 0.9％록화납1.0 ml；BF5조：0.75％포비잡인2ml+50 μ g/ml분태니0.1 ml+ 0.9％록화납0.9 ml;BF10조：0.75％포비잡인2ml+50 μg/ml분태니0.2 ml+ 0.9％록화납0.8 ml; BF20조：0.75％포비잡인2ml+ 50μg/ml분태니0.4 ml+ 0.9％록화납0.6 ml; BF30조：0.75％포비잡인2ml+ 50μ g/ml분태니0.6 ml+ 0.9％록화납0.4 ml。환자취좌측와위，선L2～3간극천자，각조분별추주요마배제액3ml。측량병기록체도최고조체평면시간、감각평면퇴도T12평면시간、운동회복시간、마취효과、진통유지시간、수술시간급불량반응。결과BF30조체도최고조체평면시간교B조、BF5조、BF10조、BF20조단(P＜0.05)，이B조화BF5조교BF10조、BF20조、BF30조장(P＜0.05)。BF20조감각평면퇴도T12평면시간교B조、BF5조、BF10조、BF30조장（P＜0.05），B조화BF5조교BF10조、BF20조、BF30조단(P＜0.05)。B조화BF5조운동회복시간화진통유지시간교BF10조、BF20조、BF30조단(P＜0.05)。B조환자발생소양례수(0)명현소우BF5조（8례）、BF10조（3례）、BF20조（6례）、BF30조（6례）（P＜0.05）。소유환자균미발생호흡억제。결론재0.75％포비잡인요마배제액중가입10 μg분태니가이축단체도최고조체평면시간，감각급운동회복시간여진통유지시간야상응연장，재30μg내저충효응병불존재제량의뢰성。
Objective To study the effect of adding various doses fentanyl to 0.75％ bupivacaine for spinal anesthetic in the population undergoing inguinal hernia repair surgery. Methods The population of 100 patients belonging to ASA class Ⅰ and Ⅱ ,scheduled for elective inguinal hernia repair, were randomized to receive a spinal anesthetic with 2 ml 0.75％ bupivacaine and 1.0 ml saline (group B),or 50 μg/ml fentanyl 0.1,0.2,0.4,0.6 ml(group BF5, group BF10, group BF20,group BF30),each group with 20 cases.Subarachnoid block was established in the left lateral position in L2-3 space by use of a midline approach. The volume of injected drug was kept constant at 3 ml. The time to the highest level of sensory block, the time for regression until T12 level, the time for complete motor recovery, the maintenance duration of the analgesia,the anesthesia effect of the groups, duration of surgery, drug-related side effects were assessed and recorded.Results The time of the highest level of sensory block in group BF30 was shorter than that in group B,group BF5, group BF 1 0, group BF20 (P ＜ 0.05 ), but group B and group BF5 was longer than group BF10,group BF20, group BF30(P ＜ 0.05 ). The time of regression to T12 level in group BF20 was longer than that in group B, group BF5, group BF10, group BF30 (P＜0.05),but group B and group BF5 was shorter than group BF10, group BF20, group BF30(P＜ 0.05 ). The time for complete motor recovery and the maintenance duration of the analgesia in group B and group BF5 was shorter than that in group BFI0,group BF20, group BF30 (P ＜ 0.05 ). The occurrence of pruritus in group B (0) was lower than that in group B F5 (8 cases),group BF10 (3 cases), group BF20 (6 cases), group BF30 (6 cases)(P＜0.05). There were no cases of respiratory depression in five groups. Conclusions It suggests that in the population receiving spinal anesthetic for hernia repair surgery, addition of 10 μ g fentanyl to 0.75％ bupivacaine significantly improves the quality and duration of analgesia. No further advantage occurs if the dose of fentanyl is increased among 30 μg.