小剂量罗哌卡因腰-硬联合麻醉在老年人下腹部及下肢手术中应用的临床观察

Application of Low-dose Ropivacaine Spinal-epidural Anesthesia in Lower Abdomen and Lower Limbs Surgery on Elderly Patients

目的观察小剂量的罗哌卡因用于老年病人下腹部及下肢手术的可行性及麻醉效果.方法择期行下腹部及下肢手术的老年患者60例,随机分为两组:(1)A组:30例,罗哌卡因腰-硬联合麻醉组,配方:0.5%罗哌卡因10mg;(2)B组:30例,0.5%左旋布比卡因10mg腰-硬麻醉组,观察感觉阻滞起效时间、运动阻滞起效时间、最高痛觉阻滞平面、最大运动阻滞程度、痛觉及运动阻滞维持时间、VAS评分、完全阻滞病人比例、术中用药情况、不良反应及血流动力学等.并连续监测ECG、NIBP、SpO2.在给药后5、10、20、30、60min时点记录BP和HR作为统计指标.结果 R组感觉阻滞起效时间、运动阻滞起效时间、达最高阻滞平面时间、达最大运动阻滞程度时间均比B组时间长,组间比较差异有统计学意义(P<0.05).R组镇痛持续时间、最大Bromage评分持续时间比B组短,组间比较差异有统计学意义(P<0.05).两组患者术中硬膜外追加局麻药例数和药量比较差异有统计学意义(P<0.05).术中医生对患者肌松效果的评价,两组均满意,但0.5%罗哌卡因组(R组)满意率比0.5%布比卡因组(B组)偏低,两组比较差异有统计学意义(P<0.05).R组注药后SBP、DBP、HR、SpO2均平稳,差异无统计学意义(P>0.05),而B组注药后3～10min的SBP、DBP下降HR增快,差异有统计学意义(P<0.05).术中两组病人疼痛、恶心和呕吐无显著性差异.结论小剂量罗哌卡因可安全应用于蛛网膜下腔阻滞,适应于老年病人下腹部及下肢手术,是一种较安全有效的麻醉方法.

Objective To observe the feasibility and anesthetic effect of low-dose ropivacaine in lower abdominal and lower limbs surgery on elderly patients.Methods Sixty elderly patients who would receive elective lower abdominal and lower limbs surgery were randomly divided into 2 groups：（1） A group：30 patients received 0.5% ropivacaine 10 mg ropivacaine spinal-epidural anesthesia;（2） B group：30 patients received 0.5% levobupivacaine 10mg spinal-epidural anesthesia.We observed the onset time of sensory block and motor block,the maximum pain block plane,the greatest degree of motor block,the lasting time of pain and motor block,VAS score,the proportion of patients with complete block,intraoperative use of medicines,and hemodynamics.And we continuously monitored ECG,NIBP,and SpO2 of patients.The BP and HR of patients at 5,10,20,30,60 min after the administration of ropivacaine were recorded as statistical indicators.Results The onset time of sensory block and motor block,the time of reaching the maximum block plane,and the time of reaching the maximum degree of motor block were longer in R group than those in B group,and there was a statistically significant difference（P〈0.05）.The lasting time of analgesia and the maximum Bromage score was shorter in R group than those in B group,and there was a statistically significant difference（P〈0.05）.There was a statistically significant difference in the cases supplemented with local anesthetics and the supplemented dose of anesthetics between the two groups.The muscular relaxation was satisfied in both groups,and the satisfying rate in R group was lower than in B group.There was no significant difference in SBP,DBP,HR,and SpO2 of patients in R group between before and after administration of anesthetics.While SBP and DBP of patients decreased and HR increased siginificantly 3～10 min after administration of anesthetics.There was no statistically significant difference in pain,sickness,and vomiting in patients between the two groups.Conclusion Low-dose ropivacaine can be used in subarachnoid block,and has no effect on BP,and the motor function recovers soon after surgery,therefore it is a safe and effective anesthetic method suitable for lower abdominal and lower limbs surgery on elderly patients