0．375％布比卡因单侧腰麻在高龄患者股骨头置换术中的临床应用

Clinical application of 0.375% bupivacaine unilateral spinal anesthesia in senile patients undergoing artificial femoral head replacement surgery

目的：观察0．375％布比卡因轻比重单侧腰麻用于高龄患者股骨头置换术的麻醉效果及安全性。方法：择期行股骨头置换手术高龄患者40例，年龄61～83岁，随机分为轻比重0．375％布比卡因单侧腰麻（SA）组（S组）和连续硬膜外阻滞（CEA）组（E组）二组，S组患侧在上（在麻醉和手术期间该体住不变），选L2-3或L3-4间隙，先行硬膜外穿刺，继以针内针实施腰麻。注入0．375％布比卡因轻比重液（0．75％布比卡因和灭茵注射用水1：1体积混合）2ml，速率0．1～0．2ml／s，置入硬膜外导管备用。根据手术时间长短决定是否追加硬膜外药。E组实施硬膜外穿刺置管，给予2％利多卡因3ml试验量，以确定导管在硬膜外腔，追加0．75％罗哌卡因8ml。观察两组麻醉对呼吸、循环功能的影响，比较两组感觉阻滞平面、感觉阻滞起效、改良Bromage评分，低血压、寒战、恶心、呕吐、头痛、神经并发症的发生率。结果：与E组比较，S组术中低血压的发生率及术中寒战、恶心、呕吐发生率均降低（P〈0．05〉）；与E组比较，S组患侧感觉阻滞平面降低（P〈0．05〉），术后患者运动、感觉恢复时间差异有显著意义（P〈0．05〉），但S组蛛网膜下腔麻醉失败2例，内针置入后无脑脊液流出或不畅需改行连续硬膜外阻滞。结论：0．375％布比卡因轻比重单侧腰麻较CEA感觉、运动神经阻滞完善、恢复快，血流动力学平稳，并发症少，用于高龄患者股骨头置换术是安全可行的。

Objective： To observed the anesthetic effect and safety of 0. 375% bupivacaine unilateral spinal anesthesia in senile patients undergoing artificial femoral head replacement surgery. Methods： 40 elderly patients undergoing selective artificial femoral head replacement surgery, aged 61-83 years old, were randomly divided into 0. 375 % bupivacaine unilateral spinal anesthesia （SA） group （S group） and continuous epidural anesthesia （CEA） group （E group）, the operated side above in group S （keep the position during anesthesia and surgery）, selected L2-3 or L3-4 intervertebral space, after epidural puncture, perform spinal anesthesia of needle in needle technique. Injected 0. 375 % bupivacaine （0.75 % bupivacaine and sterile water for injection mixed 1：1 volume） 2ml, rate 0.1 - 0. 2ml / s, placement the epidural catheter. According to the length of operation time, decided whether to add the epidural drugs or not. Peform pidural puncture in group E and use 2 % lidocaine 3 ml, to make sure the catheter is in the epidural space, then add 0.75% ropivacaine 8 ml. observed the respiratory and circulatory effect in both groups, the sensory block levels, sensory block onset, modified Bromage score, hypotension, chills, nausea, vomiting, headache, the incidence of neurological complications were compared between two groups. Results： Compared with E group, the incidence of hypotension and intraoperative shivering, nausea, vomiting in group S decreased （P〈0. 05） ; compared with E group, sensory block levels in group Slower （P〈0.05）, the difference of movement and sensory recovery time were significant （P〈 0. 05）. But there were two failure cases in group S because of cerebrospinal fluids outflow poorly. Conclusion： 0. 375% bupivacaine unilateral spinal anesthesia can block the sensory and motor nerve completely with rapid recovery, hemodynamic stability and less complications, it＇s safe and feasible for elderly patients undergoing artificial femoral head replacement surgery.