轻比重罗哌卡因在高龄患者腰-硬联合麻醉髋关节手术的应用

A clinic study on the combined spinal-epidural anesthesia in aged patients undergoing hip arthroplasty surgery

目的观察高龄患者髋关节手术小剂量罗哌卡因腰-硬联合麻醉的麻醉效果及对循环呼吸功能的影响。方法ASAⅡ或Ⅲ级髋关节手术60例,男18例,女42例,年龄(85.5±10.5)岁,体重(65.35±13.91)kg,随机分为两组,各组30例。A组腰麻用轻比重0.2%罗哌卡因5～7mg,硬膜外阻滞用0.2%罗哌卡因;B组腰麻用重比重0.5%布比卡因8～10mg,硬膜外阻滞用0.375%布比卡因硬膜外阻滞。记录两组麻醉效果和术中BP、HR、SpO2变化。结果A组麻醉平面T8～T10,单侧,术中各时点BP、HR、SpO2平稳,Bromage评分患肢1～2分,健肢0～1分;B组麻醉平面T6～T8,双侧,术中各时点BP明显下降,HR明显减慢(P<0.01),也低于A组(P<0.05),Bromage评分双下肢以3～4分为主。结论轻比重罗哌卡因腰-硬联合麻醉更适用于高龄髋关节手术患者。

Objective To observe the effects of the combined spinal-epidural anesthesia（CSEA） with small dose of ropivaeaine on the circulatory and respiratory function in aged patients undergoing hip arthroplasty surgery. Methods Sixty ASA class Ⅱ or Ⅲ patients with aged 75 to 96 years old and weighted 57 to 79 kg were divided into two groups with 30 cases each. In group A,0. 2% ropivaeaine 5-7 mg was given for spinal block and 0.2% ropivacaine for epidural block, which were 0. 5% bupivacaine 8-10 mg and 0. 375% bupivaeaine, respectively, in group B. The anesthetic efficacy, BP, HR, SpO2, Bromage score were recorded. Results The analgesic plane was Ts-10 in group A and T6-8 in group B. The changes of BP, HR, SpO2 were less in group A than those in group B. Bromage scores of group A were 1-2 for nonoperative extremity and 0-1 for the operative extremity, which were 3-4 for two extremities in group B. Conclusion The CSEA with 0. 2 % ropivacaine 5-7 mg for spinal block and 0. 2% ropivacaine for epidural block is suitable in aged patients undergoing hip arthroplasty surgery.