左旋布比卡因复合芬太尼腰-硬联合麻醉用于老年阴式全子宫切除术的观察

Observation of levobupicaeaine-fentanyl for combined spinal and epidural anesthesia in undergoing vaginal hysterectomy in aged folks

目的探讨小剂量左旋布比卡因复合芬太尼椎管内联合麻醉在老年阴式全子宫切除术中的临床效果及安全性。方法选择行老年阴式全子宫切除术患者40例,年龄60-78岁,随机分为两组:A组,左旋布比卡因5mg+芬太尼25ug与10%葡萄糖水配成2.5ml溶液20例;B组,布比卡因10mg+10%葡萄糖水配成2.5ml溶液20例。实施腰-硬膜外联合麻醉。观察并记录:两组最高阻滞平面及到达时间,改良Bromage评分法判断运动神经阻滞程度,运动神经阻滞持续时间,平面消退时间,平均动脉压和心率变化及寒战等副作用。结果所有患者麻醉镇痛完善。两组最高阻滞平面及到达时间,麻醉持续时间,肌松效果差异均无显著意义。B组低血压和寒战发生率显著高于A组(P<0.05),B组运动神经阻滞评分与阻滞持续时间显著高于A组(P<0.01)。结论左旋布比卡因复合芬太尼腰一硬联合麻醉能满足老年患者阴式全子宫切除术的麻醉要求,且副作用明显减少。

Objective To investigate the clinical effects and safety of mini dose Levobupivacaine-fentanyl for（CSEA） in undergoing vaginal hysteroctany in aged folks. Methods Selected 40 geriatric patients undergoing aged vaginal hysterectomy. Ages are in between 60 to 78 years old. The patients are randomly divided into two groups. Group A received a CSEA of Levohupivacaine 5mg plus Fentanyl 25μg plus 10% dextrose 2.5ml in 20 cases. Group B received hupiucaine 10mg, plus 10% dextrose 2.5ml in 20 eases. Both of the A and B were implemented lumbar epidural anesthesia, observed and recorded respectively the onset time of sensory block, the plane of maximum sensory block and the maintenance time of block. The Bromage scale can be used to evaluare the level of blockade, duration, plane dissipated time, the change of mean arterial blood pressure（MAP） and heart rate, shivering. Results All anesthesia are clinically satisfied. The peak sensory blockade, onset time of sensory block and muscle relaxation were not significant different between two groups. Incidence rate of hypotension and shivering in group B were significant higher than group A （p〈0.05）. The Bromage scale level and duration in group B were significant higher than group A （p〈0.01）. Conclusion Mini dose levoloupivacainefentanyl for CSEA in undergoing vaginal hysterectomy in aged folks can meet the demand of anethesia clinically and have lower side effects.