不同浓度罗哌卡因用于老年患者腰硬联合麻醉的临床观察

Clinical Observation of the Efficacy of Different Concentration Ropivacaine in the Combined Spinal-epidural Anethesia of Senil Patients

目的观察相同剂量、不同浓度罗哌卡因用于老年下腹部或下肢手术患者腰硬联合麻醉的效果,探讨罗哌卡因腰麻的最佳浓度。方法75例65岁以上择期行下腹部或下肢手术的老年患者随机分为三组,分别接受0.75%、0.5%、0.375%浓度的相同剂量(10.5mg)、等比重罗哌卡因腰麻液,观察感觉阻滞和下肢运动阻滞起效时间、最高麻醉平面、运动阻滞的Bromage分级、感觉阻滞和运动阻滞持续时间及恶心呕吐、心率减慢、低血压、TNSs等不良反应。结果与0.375%组比较,0.75%组和0.5%组感觉阻滞和运动阻滞起效时间短,持续时间长,运动阻滞的Bromage评分高(P<0.05);最高麻醉平面三组差异无统计学意义(P>0.05);心率减慢、低血压的发生率0.75%组多于0.5%组和0.375%组,但差异无统计学意义(P>0.05)。结论老年患者蛛网膜下腔使用0.5%罗哌卡因麻醉,副作用少,麻醉效果满意。

Objective To compare the different characteristics of combined spinal-epidural anesthesia（CSEA） at different concentration with the same dose ropivacaine for senil patients. Methods Seventy-five patients aged 65 years or older undergoing selective surgical treatments of lower abdomen and lower extremity were randomly allocated to receive CASE at different concentration with the same dose of isobaric ropivacaine（10.Smg）. Concentration of Group Ⅰ （n = 25） was 0.75% ; group Ⅱ （n = 25 ） was 0.5% ; group Ⅲ （n = 25 ） was 0.375%. The onset time of sensory block and of motor block, maximum block height to pinprick and the time to reach it, maximum modified Bromage scale and the time to reach it, recovery time of motor block were recorded respectively and additional side effects including nausea and vomiting,bradycardia, hypotension,TNSs. All of them were also recorded through out the whole procedures. Results When compared to the group Ⅲ ,the group I and group Ⅱ showed shorter onset time of sensory block and of motor block,longer duration of sensory block and of motor block,higher modified Bromage scale（P〈 0.05 or P〈 0.01 ）. Maximum block height to pinprick were similar among the three groups（P〉 0.05 ）. The incidences of side effects were similar among the three groups（P〉 0.05 ）. Conclusion 0.5% isobaric ropivacaine is safe and effective in CSEA for senil patients.