超小剂量罗哌卡因腰麻复合静脉用舒芬太尼用于高龄患者下肢手术麻醉的有效性和安全性观察

Efficacy and safety of ultra-low-dose ropivacaine spinal anesthesia combined with intravenous sufentanil for elderly patients with lower limb surgery

目的探讨超小剂量罗哌卡因单次腰麻用于高龄老年患者手术的有效性和手术后半期复合静脉应用舒芬太尼的安全性。方法择期下肢手术患者90例(年龄70～99岁,ASAⅡ～Ⅳ级)随机分为单次腰麻组(A组)45例和单纯硬膜外麻组(B组)45例。A组用药为0.75%罗哌卡因0.5～1.1 ml(回抽脑脊液稀释至浓度为0.5%),在腰麻效果消退患者感觉疼痛和(或)其他不适时静脉加用舒芬太尼5 μg。B组用药为0.375%罗哌卡因。观察感觉阻滞起效时间、平面固定时间、阻滞效果、腰麻注药后加用舒芬太尼时间、局麻药用量、麻醉并发症以及对呼吸循环系统的影响等。结果 A组所有病例单次腰麻效果满意,加用舒芬太尼后对呼吸循环均无影响。B组麻醉效果不佳及低血压发生率均较A组高,两组比较差异有统计学意义(P<0.01)。结论超小剂量罗哌卡因单次腰麻用于高龄老年患者手术麻醉效果确切,对血流动力学影响小,复合静脉用舒芬太尼后镇痛效果好,对呼吸循环几无影响,在临床上安全可行。

Objective To investigate the efficacy of ultra-small dose ropivacaine for single spinal anesthesia in elderly patients and the safety of intravenous sufentanil in the midanaphase of operation. Methods Ninety patients aged 70 to 99 years and Ⅱ-Ⅳ grade with ASA for elective operation of lower extremity were randomly divided into single spinal anesthesia group （group A ） and epidural anesthesia group （group B）, group A received 0. 75% ropivacaine 0. 5 - 1.1 ml （collecting cerebrospinal fluid and was diluted to 0. 5% concentration）. Administration of intravenous 5 p.g sufentanil when patients felt pain or else indisposition. Group B received epidural anesthesia with 0. 375 % ropivacaine. Onset and duration of the sensory block, the degree of the block, the time when plus sufentanil after spinal anesthesia, sensory blockade level, dose of local anesthetics, complications and effect on respiratory and cardiovascular system were assessed. Results The spinal anesthesia effectiveness of group A was good. There was no effect on respiratory and cardiovascular system after administrating sufentanil. The epidural anesthesia effectveness of group B is not good. Incidence of hypotension of group B was significantly higher than that of group A （ P 〈 0. 01 ）. Conclusion Efficacy of ultra-small dose repivacaine for single spinal anesthesia in elderly patients is certain. Combined with intravenous sufentanil is safe clinically and has little effect on respiration and circulation.