罗哌卡因复合舒芬太尼用于老年患者脊麻时不同注药速度对麻醉效果的影响

Effects of Different Injection Rate on Spinal Anesthesia for Aged Patients with Ropivacaine Combined with Sufentanil

下载PDF阅读器[目的]观察在使用罗哌卡因与舒芬太尼等比重液对老年患者行脊麻时不同推注速度对麻醉效果的影响.[方法]全髋置换老年患者60例.按行脊麻时不同局麻药物推注速度随机分为三组（A组,推注速度0.2ml/s;B组,推注速度0.1 mL/s;C组,推注速度0.05ml/s）.观察各组注药前、注药后1 min、3 min、5 min、10 min血流动力学变化情况,观察感觉阻滞起效时间、感觉阻滞最高平面、感觉阻滞持续时间及痛觉阻滞不全、恶心、呕吐、脊麻后暂时性神经症状等不良反应发生情况,并进行组间比较.[结果]与注药前比较,A组注药后1 min、3 min、5 min、10 min时,平均动脉压（MAP）降低（P〈0.05）,注药后5 min、10 min时,心率（HR）增快（P〈0.05）,B、C两组MAP及HR差异无统计学意义;A组与B、C两组比较,其感觉阻滞起效时间较短（P〈0.05）;C组与A、B两组比较,其感觉阻滞持续时间较短（P〈0.05）;C组与A、B两组比较,其疼觉阻滞不全发生率较高（P〈0.05）;A组与B、C两组比较,其恶心、呕吐发生率较高（P〈0.05）.三组患者,其术中寒颤、术中瘙痒发生率均无明显差异.三组均未观察到有脊麻后暂时性神经症状的发生.[结论]在使用罗哌卡因与舒芬太尼等比重液对老年患者行脊麻时以不同推注速度会对麻醉效果产生不同的影响：以0.2 mL/s的速度推注药物,血流血流动力学稳定性差,不良反应较多.以0.05 mL/s的速度推注药物痛觉阻滞不全发生率高,痛觉持续时间短.以0.1 mL/s的速度推注可以得到满意麻醉效果.

[Objective] To observe the effects of different injection rates on spinal anesthesia for aged patients with ropivacaine-sufentanil isobaric solution. [Methods] Sixty aged patients were randomly divided into 3 groups according to different injection rates of local anesthetics. The injection rate was 0.2ml/s in group A, 0. 1ml/s in group B and 0.05ml/s in group C. Sensory blockade, haemodynamic parameters and adverse effects such as nausea, vomi- ting and transient neurological symptoms were recorded before and after administration for 1, 3, 5 and 10 minutes and compared among groups. [Results] Compared with before administration, MaP in group A decreased at 1, 3, 5 and 10 minutes（ P 〈0.05）. After administration, HR in group A increased at 5 and 10 minutes, but there was no significant difference in MaP and HR between group B and C. The beginning time of sensory blockade effect in group A was shorter than that in group B and C, and the lasting time of sensoryblockade effect in group C was shorter than that in group A and B. The incidence of incomplete pain blockade in group C was higher than that in group A and B. The incidence of nausea and vomiting in group A was higher than that in group B and C（ P 〈0.05）, but there was no significant difference in the incidence of rigors and itching among three groups. No temporary neurological symptom occurred in all groups. [Conclusion]Different injection rates of ropivacaine-sufentanil isobaric solution have different effects on spinal anesthesia in aged patients. When the injection rate was 0.2mL/s, patients have unstable hemodynamies and more adverse effects. When the injection rate was 0.05ml/s, patients have high incidence of incomplete pain blockade and short lasting time of pain. When the injection rate was 0.01mL/s, patients can obtain satisfactory anesthesia effect with stable hemodynamics and low incidence of nausea and vomiting.