4%琥珀酰明胶在老年患者低位硬膜外麻醉中的临床应用

Clinical application of 4% succinylated gelatin in lower epidural anesthesia for elderly patients

目的：4%琥珀酰明胶注射液在老年患者低位硬膜外麻醉中应用的效果。方法：择期在硬膜外麻醉下行下肢开放复位内固定的老年患者90例,ASAⅡ或Ⅲ级,年龄65-95岁,随机分为3组（n=30）：A组在给予2%利多卡因5ml试验量前10min以20ml/min的速度输注林格液500ml;B组术中患者注入局麻药后血压开始下降时输注琥珀酰明胶500ml;C组在给予2%利多卡因5ml试验量前10min以20ml/min的速度输入琥珀酰明胶500ml。记录患者注药前（T0）、注药后5min（T1）、注药后15min（T2）的收缩压（SBP）、舒张压（DBP）、心率（HR）以及麻黄碱的使用情况。结果：A组、B组患者的SBP、DBP T2低于T0（P〈0.05）,相应的麻黄碱的使用率A组24例（80%）、B组15例（50%）相比C组的4例（13.3%）有显著差异（P〈0.01）。结论：琥珀酰明胶在老年患者低位硬膜外麻醉开始前应用能有效维持麻醉早期血压的稳定,减少升压药的使用率。

Objective：To estimate the effect of 4% succinylated gelatin in lower epidural anesthesia for elderly patients scheduled for open reduction and internal fixation from lower limb fractures. Methods ： Ninety patients aged from 65 to 95, ASA Ⅱ to Ⅲ grade, were prospectively randomized into three groups with 30 in each. Group A received Ringer＇ s solution 500 ml （20 ml/min） 10 rain before test with a dose of 2% lidocainde 5 ml, group B were given succinylated gelatin 500 ml instead of Ringer＇ solution when the blood pressure dropped and group C received sueeinylated gelatin 500 ml（ 20 ml/min） 10 rain before the test with a dose of 2% lidocaine 5 ml. SBP, DBP and FIR at the point of before administration （To）, 5 mn after administration （T1）, 15 min after administration （T2） were recorded, and the dosage of ephedrine used as well. Results ： SBP and DBP were significantly decreased from T0 to T2 in group A and B, but with no significant change in group C. There showed significant difference in ephedrine usage when group A（80% ） and B （ 50% ） compared with group C （ 13.3% ）. Conclusion ： Prophylactic administration of suceinylated gelatin in elderly patients under low level continuous epidural anesthesia can effectively maintain circulatory stability in the early stage of anesthesia and reduce the percentage of usage of vasoactive agent .