全髋关节置换术老年患者轻比重布比卡因单侧连续腰麻的效果

Efficacy of unilateral continuous spinal anesthesia with hypobaric bupivacaine in elderly patients undergoing hip replacement

目的评价全髋关节置换术老年患者轻比重布比卡因单侧连续腰麻的效果。方法拟行全髋关节置换术的老年患者60例，年龄69～98岁，性别不限，ASA II或Ⅲ级，体重46～81kg，随机分为2组（n=30）：轻比重布比卡因组（HB组）和等比重布比卡因组（IB组）。HB组和IB组分别以0．1ml／s的速率蛛网膜下腔注入0．5％轻比重布比卡因或0．5％等比重布比卡因各1ml。每隔5min测定麻醉平面和感觉、运动阻滞程度，每次追加0．5％布比卡因0．5ml，维持麻醉平面T8—T10。于注药前和麻醉平面达T8～T10时，记录血压、平均动脉压和心率；记录术中不良反应的发生情况、布比卡因用量、患肢的有效镇痛时间、有效运动阻滞时间和术后并发症的发生情况。结果与IB组比较，HB组麻醉平面达T8-T10时收缩压升高，布比卡因用量减少，患肢的有效镇痛时间和有效运动阻滞时间缩短，不良反应减少（P〈0．01）。两组术后均见未并发症发生。结论轻比重布比卡因单侧连续腰麻用于老年患者全髋关节置换术麻醉平面可控性好，血液动力学稳定，不良反应少。

Objective To evaluate the efficacy of unilateral continuous spinal anesthesia with hypobaric bupivacaine in the elderly patients undergoing hip replacement. Methods Sixty ASA II or III elderly patients of both sexes aged 69-98 yr weighing 46-81 kg scheduled for hip replacement were randomly divided into 2 groups （n = 30 each）： hypobaric bupivacaine group （group HB） and isobaric bupivacaine group （group IB）. Group HB and IB received intrathecal 0.5 % hyperbaric bupivacaine 1.0 ml and 0.5 % isobaric bupivacaine 1.0 ml both at a rate of 0.1 ml/s respectively. The level of sensory block and degree of motor block were measured every 5 rain using a pinprick test and modified Bromage scale respectively. 0.5 % bupivacaine was given in 0.5 ml increments every time to maintain the block level at T8-T10 . BP, MAP and HR were recorded before intrathecal injection and at the time when the block level reached T8-T10. Adverse effects, total amount of bupivacaine consumed, duration of analgesia and duration of motor block during operation were recorded. The complications were also recorded during 2 weeks after operation. Results Compared with group IB, SP at the time when the block level reached T8-T10 was significantly increased, the total amount of bupivacaine consumed was decreased, duration of analgesia and duration of motor block were shortened, and adverse effects were decreased in group IB （ P 〈 0.01 ）. No complications were observed after operation in both groups. Conclusion The unilateral continuous spinal anesthesia with hypobarie bupivacaine produces controlled sensory block level with stable hemodynamics and less adverse effects in the elderly patients undergoing hip replacement.