低比重0.4%左旋布比卡因腰硬联合麻醉在高龄老人股骨头置换术中的应用

The application of low Specific gravity 0.4%levobupivacaine for CSEA in elder patients undergoing replacemen t of total hip

目的探讨低浓度轻比重左旋布比卡因用于老年患者股骨头置换术中的麻醉效能及安全可行性。方法选择拟施该手术的老年患者80例,随机分为两组,一组为左布组(左旋布比卡因组),一组为布比组(布比卡因)。左布组以轻比重的0.4%左旋布比卡因1.5～2 ml实施腰麻而后置管,依手术时间及麻醉情况硬膜外腔适时补充给药,硬膜外用药为2%利多卡因;布比组给轻比重布比卡因1.5～2 ml,两组麻醉平面均调控在T_(10)以下。术中持续监测BP、ECG、RR及SpO_2,比较麻醉诱导时间、维持时间,并据镇痛效果、肌肉松驰程度,短暂性神经综合症来评定麻醉效果。结果两组镇痛效果无显著差异,左旋布比卡因组肌松差于布比组,麻醉时间短于布比组,术后麻醉药毒性明显少于布比组。结论左旋布比卡因在镇痛和最高平面和布比卡因无显著差异,但比布比卡因更可靠、更更安全。

Objective To discuss the anesthesia effect and its safety of low specific gravity 0. 4% levobupivaeaine for CSEA in elder patients undergoing replacement of total hip. Methods 80 cases of such patient were divided into two groups （n =40 each） randomly, levobupivacaine group was performed with spinal anesthesia after epidural anesthesia with intra nee- dle, then given 0. 4% levobupvacaine 1.5 -2 ml （prepared with sterile water for injection） after the epidural catheter insert- ed. Adjust their operating table according to the angle block plane and controlled it at T10, and the anesthesia was maintained with epidural administration with 2% lidoeaine if necessary. Bupivaeaine group given 0. 4% bupivaeaine 1.5 - 2 ml （ prepared with sterile water for injection） for spinal anesthesia. Continuous monitoring BP,HR,ECG and SpO2 ,anesthesia levels,the onset timing of blockade, the maintenance of blockade timing, anesthesia effect, transient neurological syndrome. Results Anesthesia effect, complications of anesthesia were similar in the two groups. The onset time of sensory block and the block reached the highest plane of time between these two groups was not significant. The difference of modified Bromage score between these two groups was significantly higher than in Bupivacaine group. While Bupivacaine group has 2 cases affected with postoperative neurotoxicity（ transient neurological syndrome ）. Conclusion The analgesic effect of spinal anesthesia with 0. 4% levobupivaeaine of replacement of total hip is same to bupivacaine, but is feasible and safe.