轻比重罗哌卡因单侧连续腰麻用于老年患者全髋关节置换术

Efficacy of Unilateral Continuous Spinal Anesthesia with Hypobaric Ropivacaine in Elderly Patients Undergoing Hip Replacement

目的:评价轻比重罗哌卡因单侧连续腰麻在老年患者全髋关节置换术中的效果。方法:拟行全髋关节置换术的老年患者60例,随机分为轻比重罗哌卡因组(HR组)和等比重罗哌卡因组(IR组),(n=30)。HR组和IR组分别以0.1 mL/s的速率蛛网膜下腔注入0.5%轻比重罗哌卡因或0.5%等比重罗哌卡因各1 mL。每隔5 min测定麻醉平面和感觉、运动阻滞程度,每次追加0.5%罗哌卡因0.5 mL,维持麻醉平面T8～T10。于注药前和麻醉平面达T8～T10时,记录血压、平均动脉压和心率;记录术中不良反应的发生情况、罗哌卡因用量、患肢的有效镇痛时间、有效运动阻滞时间和术后不良反应的发生情况。结果:与IR组比较,HR组麻醉平面达T8～T10时收缩压升高,罗哌卡因用量减少,患肢的有效镇痛时间和有效运动阻滞时间缩短,不良反应减少(P<0.01)。两组术后均未见并发症发生。结论:轻比重罗哌卡因单侧连续腰麻用于老年患者全髋关节置换术麻醉平面可控性好,血流动力学稳定,不良反应少。

Objective To evaluate the efficacy of unilateral continuous spinal anesthesia with hypobaric ropivacaine in the elderly patients undergoing hip replacement.Methods Sixty elderly patients scheduled for hip replacement were randomly divided into hypobaric ropivacaine group(group HR) and isobaric ropivacaine group(group IR),(n=30 each).The patients in group HR and IR received intrathecal injection with 0.5% hyperbaric ropivacaine 1.0 mL and 0.5% isobaric ropivacaine 1.0 mL at a rate of 0.1 mL/s,respectively.The levels of sensory block and degree of motor block were measured every 5 minutes using a pinprick test and modified Bromage scale respectively.The block level at T8~T10 was maintained with 0.5% ropivacaine by 0.5 mL increments every time.BP,MAP and HR were recorded before intrathecal injection and at the time of the block level reached T8~T10.Adverse reaction,total amount of ropivacaine consumed,duration of analgesia and duration of motor block during operation were recorded.The complications were also recorded during two weeks after operation.Results Compared with group IR,SBP at the time of the block level reached T8~T10 was significantly increased,the total amount of ropivacaine consumed was decreased,duration of analgesia and motor block were both shortened,adverse effects were decreased in group HR(P<0.01).No complications were observed after operation in both groups.Conclusion The unilateral continous spinal anesthesia with hypobaric ropivacaine produces controlled sensory block level with stable hemodynamics and less adverse reaction in the elderly patients undergoing hip replacement.