高龄患者髋部骨科手术应用腰硬联合麻醉的安全性观测

The safety of application of combined spinal and epidural anesthesia to hip surgery on the elderly

目的:观测高龄患者髋部骨科手术应用腰硬联合麻醉效果及其安全性。方法:47例患者(年龄均为70岁以上)在腰硬联合麻醉下行髋部骨科手术;麻醉药物为0.5%布比卡因7.5mg￣10mg(0.75%布比卡因1￣1.4ml加脑脊液0.5￣1ml稀释,比重为1.010)。记录麻醉起效时间和麻醉平面、镇痛和肌松效果;监测血压、心率和脉搏氧饱和度变化情况。结果:注药完毕即出现足部发热、下肢麻木40例,7例注药后3min开始足部发热;最高麻醉平面(T6)3例,T10￣1240例,T7￣94例;术中镇痛及肌松满意度为100%;麻醉后血压和心率变化不明显。结论:腰硬联合麻醉在高龄髋部骨科手术具有用药少、起效快、镇痛完善、肌松效果好,对循环系统干扰较小的优点,是一种安全可靠的麻醉方法。

Objective： To observe the effect and safety of application of combined spinal and epidural anesthesia to hip surgery on the elderly. Methods： 47 patients aged over 70 years underwent hip surgery; All patients were given combined spinal and epidural anesthesia with 7.5mg-10mg of 0.5% bupivacaine （1-1.4ml of 0.75% bupivacaine was attenuated with 0.5-1ml of cerebrospinal fluid; density：1.010）. The time to anesthesia,sensory block levels and the effect of analgesia and muscle relaxation were recorded; BP,HR and SPO2 were monitored. Results： Foot febrile and lower limb numbness appeared in 40 patients immediately after drug administration; foot febrile appeared in 7 patients 3min after drug administration. There were 3 patients at the highest sensory block levels （T6）,40 patients at T10-12 and 7 patients at T7-9. Combined spinal and epidural anesthesia could provide 100% satisfactory analgesia and muscle relaxation during operation. BP and HR had no obvious variation after anesthesia. Conclusion： The application of combined spinal and epidural anesthesia has the advantage of low-dosage,fast-acting,consummate analgesia,satisfactory muscle relaxation and small interference with recirculating and respiratory system; etc, and so it is safe and effective for hip surgery on the elderly.