轻比重左旋布比卡因腰麻-硬膜外联合麻醉在高龄患者下肢手术中的应用

Application of Combined Spinal-epidural Anesthesia with Hypobaric Levobupivacaine in Elderly Patients with Lower Extremity Operation

目的探讨低比重左旋布比卡因腰麻-硬膜外联合麻醉在高龄患者下肢手术中的临床效果及可行性。方法选择拟行下肢手术的高龄患者60例,年龄75～93岁,ASAⅡ～Ⅲ级,体质量42～76Kg,随机分为两组,每组30例。LB组蛛网膜下腔给予0.2%轻比重左旋布比卡因3mL,B组蛛网膜下腔给予0.2%轻比重布比卡因3mL。监测麻醉前、麻醉中及麻醉后BP、HR、SpO2的变化,测定感觉阻滞平面及下肢运动阻滞效果,观察麻醉效果及不良反应。结果两组感觉及运动阻滞程度无明显差异,两组麻醉效果均满意,B组不良反应发生率高于LB组。结论轻比重左旋布比卡因腰麻-硬膜外联合麻醉用于高龄下肢手术效果满意。

Objective To explore the effect and feasibility of spinal-epidural anesthesia with hypobaric levobupivacaine in elderly patients with lower extremity operation. Methods 60 patients who scheduled for lower extremity operation, aged from 75 to 93 years old, ASA Ⅱ-Ⅲ, body weight 42～76 kg, were randomly assigned to two groups with 30 cases each. Patients in group LB and B were respectively given 0.2% hypobaric levobupivacaine and bupivacaine 3 ml in subarachnoid cavity. BP,HR and SpO2 were monitored before, during and after the anesthesia. The following items were recorded： level of sensory block, degree of motor block, anesthetic effect and adverse effects. Result There was no signif icant differences in sensory and motor block between 2 groups. Both groups showed satisfactory anesthetic effect. The rate of adverse effects in group B was higher than that of group LB. Conclusions Combined spinal-epidural anesthesia with hypobaric Levobupivacaine was safe and suff icient in elderly patients with lower extremity operation.