小剂量布比卡因、芬太尼脊麻用于老年病人行髋部手术

Low-dose bupivacaine-fentanyl spinal anesthesia for hip surgery in geriatic patients

目的 探讨鞘内阿片类药物与小剂量局部麻醉药联合应用是否获得满意的脊麻效果,并观测其用于老年病人实施髋部手术的安全性。方法 选择40例年龄为65-86岁,ASAⅡ-Ⅲ级的择期髋部手术病人,随机分为A、B两组,每组20例。A组脊麻用药为布比卡因5mg与芬太尼20μg; B组为布比卡因10mg。收缩压小于90mmHg或平均动脉压较基础水平下降25％定义为低血压。低血压用麻黄碱5-10mg静脉注射,最大剂量为50mg,如仍未改善则改用去氧肾上腺素100-200μg静脉注射。结果 所有病人均获得满意的效果。A组仅有3例使用麻黄碱,平均用量为1.5±2.4mg;B组有18例使用血管加压药物维持血压,麻黄碱平均使用量为34±8mg,有4例使用去氧肾上腺素。A组收缩压、舒张压,麻黄碱平均使用量为34±8mmHg,有4例使用去氧肾上腺素。A组收缩压、舒张压、平均动脉压最低时分别下降到103±21mmHg、66±17mmHg、84±12mmHg;而B组为84±23mmHg、57±13mmHg、67±15mgHg,差异显著。结论 小剂量布比卡因5mg与芬太尼20μg 联合使用行脊麻可满足老年病人实施髋部手术。与10mg布比卡因相比,小剂量联合使用较少引起低血压,安全性高。

Objective to explore whether intrathecal opioids combined with low-dose local anesthetics may achieve reliable spinal anesthesia. Methods Forty geriatic patients undergoing hip bone surgery were randomized into two groups with 20 each. Group A received bupivacaine 5mg plus fentanyl 20μg,and group B received 10mg bupivacaine alone. Hypotension was defined as a systolic pressure of less than 90 mmHg or a 25% decrease in mean arterial pressure from baseline. Hypotension was treated with intravenous ephedring boluses 5-10mg up to maximum 50mg, and thereafter by phenylephrine boluses 100-200μg. Results All patients had satisfactory anesthesia. Three of 20 patients in group A required an average of 1. 5mg ephedrine. Eighteen patiets in group B needed an average of 34mg ephedrine, and four of those phenylephrine. The lowest systolic, diastolic, and mena blood presure were, respectively, (103?±21), (66±17),and (80±12)mmHg in group A versus (84±23) , (57?±13), (67±15)mmHg in group B. Conclusions A low dose of 5mg bupivacaine combination with 20μg fentanyl provides spinal anesthesia for hip surgery in geriatic patients and has less hypotension than 10mg bupivacine.