罗哌卡因腰麻联合硬膜外麻在老年患者中的临床应用

Clinical application of combined spina-epidural anesthesia with Ropivacaine in the elders

目的:观察罗哌卡因用于老年腰麻-硬膜外联合麻醉的临床效果和不良反应,并与布比卡因进行比较。方法:选择96例行下腹、下肢手术的老年患者,随机分为两组:罗哌卡因(R)组48例和布比卡因(B)组48例,采用CSEA麻醉。术中监测患者血压、心率、氧饱和度、麻醉平面及下肢运动阻滞情况,并记录恶心、呕吐、头痛等不良反应。结果:两组麻醉平面﹑不良反应发生率差异无统计学意义,术中下肢运动阻滞,R组明显弱于B组且术后下肢运动阻滞消退快于B组(P<0.05)。结论:罗哌卡因与布比卡因用于老年患者CSEA皆能达到满意的麻醉和术后镇痛效果,罗哌卡因运动阻滞弱于布比卡因,更有利于患者术后早期下床活动及胃肠功能的恢复。

Objective： To compare the anesthetic and analgesic efficacy of Ropivacaine, bupivacaine and their side reactions in combined spinal-epidural anesthesia and postoperative analgesia in the elders. Methods： 96 elderly patients undergoing lower abdomen and limbs operation were randomly assigned to receive either Ropivacaine （Group R, n=48） or Bupivaeaine（Group B, n=48）for CSEA. The observed variables were the changes in BP, HR, SpO2, block level, and motion block. recession of motor block, and the incidence of headache, nausea and vomiting, leg numbness within 24 h after operation. Results： There was no significant difference between two groups either in block level or in side reactions. Motor block was much milder in group R than that in group B, and recessed faster after operation （P〈0.05）. Conclusion： Either Ropivacaine or Bupivaeainc can he used in CSEA for analgesia during and after operation in the elders. However, Ropivaeaine has a milder motion block than bupivacaine, which benefits early ambulation after operation and recovery of gastrointestinal function.