罗哌卡因连续腰麻对高龄患者血液动力学的影响

Hemodynamic effects of continuous spinal anesthesia with ropivacaine in aged patients

目的对比连续腰麻（cantinuous spinal anesthesia，CSA）和单次小剂量腰麻（spinalanesthesia，SA）用于高龄患者下肢手术对血液动力学的影响。方法选择75岁以上，ASAⅡ-Ⅲ级，择期行下肢手术的患者40例，抽签随机分成连续腰麻组（CSA组）和单次腰麻组（SA组），每组20例。CSA组首次给予0．5％重比重罗哌卡因5mg，追加剂量为每次2．5mg，使感觉阻滞平面达到T12。SA组单次给予0．5％重比重罗哌卡因10mg。观察时间为腰麻给药后1h。结果2组患者一般情况、ASA分级、出血量和输液量差异无统计学意义。CSA组患者罗哌卡因用量为（7．9±0．9）mg，SA组为10mg，2组相比差异有统计学意义（P〈0．05）。2组患者感觉阻滞平面和运动阻滞程度为差异有统计学意义（P＜0．05）。2组患者各时间点（给药前、给药后5、10、15、30、45、60min）的平均动脉压和心率为差异无统计学意义。但2组发生低血压的例数（CSA组2例，SA组8例）和麻黄碱使用量[CSA组（5．0±0．0）mg，SA组（10．0±2．7）mg]差异有统计学上意义（P〈0．05）。结论0．5％重比重罗哌卡因CSA用于高龄患者下肢手术麻醉效果确切，对血液动力学影响小，麻黄碱用量少，在临床上安全可行。

Objective To compare the hemodynamic effects of continuous spinal anesthesia （CSA） and small does single injection spinal anesthesia （SA） in 75 years or older patients. Methods In a prospective study, 40 American Society of Anesthesiologists Ⅱ -Ⅲ patients （aged 75 yr or older）, undergoing elective lower extremity surgery were randomLy assigned to either group CSA or group SA （n=20）. Group CSA received a starting dose of 5rag of 5% hyperbaric ropicaine, followed after 15 min by reinjecion of 2.5 mg every 5 min until a T12 level sensory block was reached, and SA patients received 10 mg of 5% hyperbaric ropicaine. Results There was no difference between two groups in the age, sex, main complications, fluid infusion and blood loss. Using univariate analysis, we found no differences between the groups in regards to MAP and HR from the beginning of anesthesia to one hour after anesthesia. In the CSA group, however, 2 patients experienced at least one episode of hypotention, while 8 patients in the SA group（P〈0.05 ）. In the CSA group, （5.0±0.0） mg ephedrine was injected, while（ 10.0±2.7 ） mg in the SA group（P〈0.05）. In the CSA group, （7.9±0.9） mg ropicaine was required, while 10 mg in the SA group （P〈0.05）. Conclusion In aged patients undergoing lower extremity surgery, CSA provides fewer episodes of hypotension and fewer ephedrine usage compared with SA.