0.375%左旋布比卡因用于老年患者全髋置换术腰麻30例

30 Cases of Spinal Anesthesia with 0.375% Hyperbaric Levobupivacaine in Elderly Patients Undergoing Total Hip Replacement

目的比较0.375%左旋布比卡因腰麻联合硬膜外麻醉(CESA)同左旋布比卡因加利多卡因硬膜外麻醉在老年患者全髋置换术中的麻醉效果。方法择期行全髋置换术的老年患者60例,年龄65～92岁,随机分为2组,每组30例。腰麻联合硬膜外麻醉组(C组)选L2,3或L3,4间隙行硬膜外穿刺,患侧肢体在下,穿刺成功后注入0.375%左旋布比卡因3mL,观察麻醉效果并根据阻滞平面通过硬膜外追加局麻药,麻醉成功后15min改为患侧肢体在上手术体位。连续硬膜外组(E组)同C组穿刺,患侧肢体在上,穿刺成功后分次注入1%利多卡因加0.25%左旋布比卡因混合液57mL,并在手术开始时调整麻醉平面至T10。观察两组麻醉前(t0基础值)和给予首剂量麻醉药后1min(t1)、3min(t2)、5min(t3)、10min(t4)、15min(t5)、30min(t6)、1h(t7)、2h(t8)、术毕(t9)及术后15min(t10)循环、呼吸功能的变化,比较两组感觉阻滞平面、改良Bromage评分、术中及术后3d内心动过缓、低血压、寒战、恶心、呕吐、头痛、神经系统并发症的发生率。结果 C组平均动脉压(MAP)在t2～4降低,E组MAP在t4～6降低(P<0.05)。C组MAP在t2时明显低于E组(P<0.05);两组动脉血氧饱和度(SaO2)在t2～10均升高,但组间差异无显著性。C组患侧感觉阻滞范围比E组增宽(P<0.05),C组非患侧改良Bromage评分明显差于患侧和E组。结论老年患者全髋置换术行0.375%左旋布比卡因腰麻比0.25%左旋布比卡因加1%利多卡因硬膜外麻醉的效果更好,在先给以扩容等处理的情况下不增加低血压等并发症的发生率。

Objective To compare spinal anesthesia（SA） with 0.375% hyperbaric levobupivacaine and epidural anesthesia with levobupivacaine added with lidocaine in elderly patients undergoing total hip replacement. Methods Sixty ASAⅠ-Ⅲ patients aged 65-92 were randomized to one of two groups：group C epidural combined with spinal anesthesia（CESA）（n=30） and group E only epidural anesthesia（EA）（n=30）.Patients in group C were performed at L2,3 or L3,4 interspace with epidural puncture in the lateral position with diseased leg down most.The patients received spinal catheter with hyperbaric 0.375% levobupinacaine solution 3 mL. Patients in group E were performed at same interspace with the patients in the lateral position but the diseased leg upper most. 0.25% levobupivacaine and 1% ledocaine solution 5-7 mL was injected into epidural needle. Parameters of circulation and respiration data were recorded in the time of baseline（t0）,after injected 1 min（t1）,3 min（t2）,5 min（t3）,10 min（t4）,15 min（t5）,30 min（t6）,1 h（t7）,2 h（t8）,operation end（t9）and after operation 15 min（t10）.The regional of blocked and degree of motor blockade and the intraoperative and postoperative complications like bradycardia,hypotension so forth,associated with spinal and epidural anesthesia were measured and recorded. Results Compared with baseline,MAP in group C was decreased at time of t2-4,and so did in group E at time of t4-6（P0.05）. There was significant increasement in t2-10 of SaO2 and no significant change in HR during operation in both groups. There was significant difference of motor blockade degree in group C between two laterals（P0.05）.The motor blocked area of disease lateral was wider than contrary lateral and that of group E（P0.05）. The modified Bromage evaluation in Group C of noninjured side was worse than that of the injured side and group C. Conclusion The spinal anesthesia of 0.375% levobupinacaine for elderly patients undergoing total hip replacement are more effective than that of 0.25% levobupivacaine and 1% ledocaine. The suitable volume of liquid supplied for patients before anesthesia won＇t increase the incidence of complications as hypotention.