轻比重液单侧腰麻用于高龄患者下肢手术的临床研究

Light specific gravity solution used in unilateral spinal anesthesia in senile patient subject to the lower limb operations

目的探讨单侧腰麻用于高龄患者下肢手术的可行性,比较不同配方轻比重布比卡因在高龄患者下肢手术中的优劣。方法92例行下肢手术的高龄患者随机分为A、B、C三组,各组使用的腰麻液用量为:0.167%布比卡因溶液3ml(A组);0.25%布比卡因溶液2ml(B组);0.375%布比卡因溶液2ml(C组)。比较3组临床麻醉效果及不良反应的差异性。结果3种不同配方的布比卡因均可产生一个单侧感觉、运动神经阻滞的麻醉效果。A组与B组(相同剂量不同容量)比较:麻醉起效时间、麻醉平面固定时间、有效镇痛时间,差异无统计学意义(P>0.05),最高阻滞平面T6(T4～T8)的例数A组较B组多,差异有统计学意义(P<0.05)。B组与C组(不同剂量相同容量)比较:麻醉起效时间、麻醉平面固定时间,差异无统计学意义(P>0.05),但在麻醉有效镇痛时间上C组明显优于B组,差异有统计学意义(P<0.01),最高阻滞平面T6(T4～T8)的例数C组较B组多,差异有统计学意义(P<0.01)。结论3种不同配方的布比卡因均可产生一个单侧腰麻的效果,适合于2h以内的老年下肢手术,可选择B组的腰麻配方,超过2h以上的手术可选择C组的腰麻配方。

Objective To discuss the feasibility of unilateral spinal anesthesia used in the senile patients subject to lower limb operations and compare the effects of three kinds of different specific gravity bupivacaine.Methods Ninety-two senile patients subject to the lower limb operations were randomly divided into groups A,B and C receiving 0.167% bupivacaine 3 ml, 0.25% bupivacaine 2 ml and 0.375% bupivacaine 2 ml respectively.The anesthetic effects and side reactions were compared among three groups.Results Three kinds of light specific gravity bupivacaine all produced the effects of unilateral anesthesia and dyskinesia.The comparison between group A and group B indicated that there was no significant difference in the anesthetic start time,anesthetic level immovable time and effectively antalgic time (P> 0.05),but the upmost anesthetic level in group A was significantly higher than in group B (P< 0.05).It was also found there was no significant difference in anesthetic start time and anesthetic level immovable time between between group B and group C (P> 0.05),but there was significant difference in effectively antalgic time and upmost anesthetic level between them (P< 0.05).Conclusion Three kinds of light specific gravity bupivacaine all make the effects of unilateral spinal anesthesia.They all can be used in the senile patients subject to lower limb operations.We can select the solution of group B in the operation less than 2 h.If the operation time is more than 2 h,we can use the solution of group C.