0．75％速卡腰硬联合麻醉在老年患者全髋置换术中的应用

Application of CSEA with 0. 75 % levobupivacaine in old patients undergoing total hip replacement surgery

目的探讨0．75％速卡（左旋布比卡因）腰硬联合麻醉在老年患者全髋置换术中的I临床麻醉效果和可行性。方法60例老年全髋置换术患者随机分为两组，每组30例。B组使用0．75％布比卡因，L组使用0．75％左旋布比卡因，两组均行腰硬联合麻醉（CSEA），鞘内各注人15mg。术中必要时经硬膜外导管注入1．5％利多卡因。术中监测BP、HR、SpO：、R的变化并观察感觉阻滞起效时间、最高感觉阻滞平面、达最高感觉阻滞平面时间、运动阻滞评分以及围术期不良反应的发生。结果两组感觉阻滞起效时间差异无显著性（P〉0．05）；最高感觉阻滞平面L组略低于B组，但差异无显著性；达最高感觉阻滞平面时间L组略短于B组，但无显著性差异；两组患者运动阻滞评分差异无显著性；两组均无神经系统的不良反应。结论0．75％速卡（左旋布比卡因）腰硬联合麻醉用于老年患者全髋置换术中对血流动力学影响小，其临床麻醉效果是安全可行的。

Objective To evaluate the efficacy and safety of 0. 75% levobupivacaine for combined spinal and epidural anesthesia （CSEA） in old patients undergoing total hip replacement surgery. Methods Sixty ASA I - II patients, scheduled for selective total hip replacement surgery, were randomly divided into two groups. The patients in group L, received 0. 75 % levobupivacaine 15 mg （2 ml）for spinal anesthesia, and those in group B, received same amount of 0. 75% bupivacane. 2% lidocaine was supplemented via epidural catheter when spinal analgesia was inadequate. During operation, BP, HR and SpO2 were monitored continually. Sensory and motor blockade, side effects were recorded. Results The plane of block, onset time, duration of blockade, motor block were comparable between two groups. There was no neural side effects in both groups. Conclusion 0.75% levobupivacaine for CSEA is effective and safe for total hip replacement surgery.