0.2%左布比卡因轻比重腰-硬联合麻醉用于侧卧位下全髋关节置换手术的临床观察

Clinical study on the combined anesthesia of lumbar with 2% levobupivacaine and epidural on lateral position of replacement of total hip

目的 观察0．2％左布比卡因轻比霞腰-硬联合麻醉（CSEA）用于侧卧位下全髋关节置换术的麻醉效果及其安全术。方法侧卧位下全髋关节置换手术120例，随机分为2组：CSEA组（Ⅰ组，60例）和硬膜外麻醉（EA）组（Ⅱ组，60例）。Ⅰ组先行硬膜外穿刺，继以针内针实施腰麻。脑脊液流出，将腰麻针斜面向患侧，以0．2．0．3ml／s的速度注入0．2％左布比卡因6—7ml（用火菌注射用水配制）后置入硬膜外导管。根据阻滞平面情况调节手术台角度，阻滞平面上界控制在T9-T12。Ⅱ组实施硬膜炎外穿刺置管，给予2％利多卡因5ml，为试验量以确定导管在硬膜外腔。追加0．75％左布比卡因12ml。结果Ⅰ组感觉阻滞起效时间及达最高阻滞平面时间显著低于Ⅱ组（P〈0．05或P〈0．01）。骨性操作期间视觉模拟平分（VAS）比较，Ⅰ组低于Ⅱ组（P〈0．05）。2组改良Bromage评分差异无统计学意义（P〉0．05），而Ⅰ组组内患侧与健侧VAS及改良Bromage评分差异有统计学意义（P〈0．05）。结论0．2％左布比卡因轻比重CSEA用于侧卧位下全髋关节置换手术，镇痛效果优于硬膜外麻醉，安全可行。

Objective To discussed the anesthesia effect and its safety on the combined lumbar with 2% levobupivacaine and epidural anesthesia of replacement of total hip. Methods 120 cases of such patient were divided into two groups randomly. CSEA group was performed with lumbar anesthesia after epidural anesthesia with intra-needle. Cerebrospinal fluid outflow,will be facing the ipsilateral spinal anesthesia needle ramp to 0.2 -0.3ml/s injection rate of 0.2% levobupivacaine 6 -7ml （prepared with sterile water for injection）after the epidural catheter inserted. Adjust their operating table according to the angle block plane and controlled it at T9 -T12. Group Ⅱ implemented the epidural catheterization, given 2% lidocaine 5ml to determine the amount of catheter in the epidural space. An additional 0.75% levobupivacaine 12ml. Results The onset time of sensory block and the block reached the highest plane of time of group Ⅰ was significantly lower than in group Ⅱ （ P 〈 0. 05 or P 〈 0.01 ）. During operation, visual analogue scale （VAS） in bone split compared, the scale of group Ⅰ was lower than in group Ⅱ （ P 〈 0. 05 ）. The difference of modified Bromage score between these two groups was not significant （ P 〉 0. 05 ）, while group affected side and contralateral differences in VAS and the modified Bromage score of group I was statistically significant （ P 〈 0. 05 ）. Conclusion The analgesic effect of combined lumbar with 2% levobupivacaine and epidural anesthesia of replacement of total hip superior to epidural anesthesia,is feasible and safe.