不同比重布比卡因连续腰麻对老年髋关节手术平面可控性的影响

Influences of continuous spinal anesthesia with different specific gravity bupivacaine on controllable level of hip joint procedures for elderly patients

目的比较不同比重布比卡因对老年髋关节手术平面可控性的影响。方法将54例接受髋关节置换术的老年患者分为观察组与对照组(均为n=27),于蛛网膜下腔分别注射轻比重及等比重布比卡因,比较注射前及维持麻醉所需可控平面时的生命征,比较两组布比卡因用量、感觉既运动阻滞起效及维持时间,可控平面位置及Bromage分级。结果①两组患者的一般情况以及注药前的生命征无统计学差异,且术后无出现马尾综合征等并发症;②生命征方面,当麻醉平面达T8～T10时,两组患者的收缩压均显著低于注药前,且对照组的收缩压及平均动脉压低于观察组(P<0.05);③麻醉效果方面,观察组的布比卡因用量显著低于对照组(P=0.029);观察组的感觉及运动阻滞起效时间显著短于对照组(P=0.032、0.027),且观察组的麻醉维持时间显著长于对照组(P=0.042),但两组患者的麻醉可控平面无统计学差异(P=0.162)。结论轻比重及等比重布比卡因在老年髋关节手术平面可控性均较理想,但轻比重布比卡因对血压的影响及用量更小,且麻醉效果优于等比重布比卡因。

Objective To explore the influence of different specific gravity bupivacaine on the anesthesia level for the aged patients needed hip replacement.Methods 54 patients were divided into the observation group and control group（both n=27） and the former of which received intrathecal 0.5% hypobaric bupivacaine in dose of 1.0 ml,whereas the latter received 0.5% isobaric bupivacaine for 1.0 ml.The vital signs,level of anesthesia,doses of bupivacaine,time to onset and the holding time of bupivacaine were observed and compared.Results 1） There were no difference of the general conditions and vital sign between the two groups before bupivacaine injection.Besides,none of 54 patients occurred syndrome of cauda equina or the other complications after the operation.2） On the anesthesia control level of T8～T10,lower and wider fluctuations of both systolic pressure and mean arterial pressure were seen in the control.3） About the anesthetic effect：In the use of bupivacaine dose,observation group was significantly lower than that control group（P=0.029）.In the sensation and motor block onset time,the observation group was significantly shorter than that control group（P=0.032,0.027）.But in the continuous anesthetic time,the observation group was significantly longer than that control group（P=0.042）.However,there was no statistically difference of the anesthesia level between the two groups.Conclusion Both hypobaric and isobaric bupivacaine have ideal control of anesthesia level for the aged patients needed hip replacement,but the hypobaric one would display its superiority on more stable blood pressure and lower doses.