不同比重布比卡因在老年患者腰硬联合麻醉中的临床观察

The Clinical Investigation of Different Proportion of Bupivacaine for Spinal-epidural Anesthesia in the Elderly Operations

目的:探讨不同比重布比卡因腰硬麻醉在65岁以上老年人下腹部、下肢手术的安全有效性以及对血流动力学的影响。方法:120例择期手术患者随机分为3组,Ⅰ组给予0.5%重比重布比卡因2ml,Ⅱ组给予0.5%轻比重布比卡因2ml,Ⅲ组给予0.5%等比重布比卡因2ml。所有患者围术期监测并记录麻醉前(T1)基础值,麻醉后5min(T2)、10min(T3)、15min(T4)、30min(T5)、60min(T6)时血压、心率、氧饱和度等。结果:所有患者均在腰硬麻醉下完成手术。给药后I组患者均出现不同程度的血压下降,需加快输液并给予麻黄碱后得以纠正。II组患者有14例出现血压下降,需加快输液并使用麻黄碱纠正。Ⅲ组患者血循环稳定,麻醉效果满意。结论:对老年下腹部、下肢手术的患者选择等比重布比卡因行腰硬麻醉是一种方便、安全有效的方法,值得推广。

Objective：To investigate the safety and effect of different proportion of bupivaeaine spinal-epidural anesthesia in the elderly that over 65 years lower abdomen, lower limb surgery, as well as the effect of hemodynamies. Methods： 120 cases of periodic operation were randomly divided into three groups, group Ⅰ were given 0. 5% hyperbaric bupivaeaine 2ml,group Ⅱ were given 0. 5% hypobaric bupivacaine 2ml, group Ⅲ were given 0. 5% isobaric bupivaeaine 2ml. All the patients in perioperative period were monitored , and the data of blood pressure, heart rate, Oxygen saturation etc. before anesthesia （T1）, and 5min（T2 ）, 10min（T3 ）, 15min（T4 ）, 30min（T5 ）, 60min（T6 ）after anesthesia were recordeck Results：All patients in the spinal-epidural anesthesia had completed the operation. After administration, all patients in group Ⅰ had varying degrees of blood pressure drop,and were rectified by accelerating the infusion and the use of ephedrine. In group Ⅱ, 14 patients had blood pressure drop, and were rectified by accelerating the infusion and the use of ephedrine; patients in group Ⅲ had stable blood circulation, and the anesthetic effect were satisfied. Conclusion： For the old patients with lower abdomen, lower limb surgery, isobaric bupivacaine spinal-epidural anesthesia is a convenient, safe and effective method, it is worth to promot.