高龄髋关节置换者实施不同密度腰麻-硬膜外联合麻醉效果的评价

Effect of spinal-epidural anesthesia with different proportions on elderly hip replacement

背景:目前老年髋关节置换常用的麻醉方法有等密度,高密度,低密度腰麻-硬膜外联合麻醉。比较不同密度腰麻-硬膜外联合麻醉在老年髋关节置换中的应用效果,以寻求最好的用药方案。目的:对高密度、等密度、低密度的麻醉用药方案、麻醉起效时间、麻醉维持时间、Bormage运动阻滞评分进行分析。方法:以"髋关节置换术,腰麻-硬膜外联合麻醉;以:"hipreplacement,combinedspinal-epduralanesthsia"为英文关键词,采用计算机检索2000-01/2011-05相关文章。纳入与有关髋关节置换术腰麻-硬膜外联合相关的文章;排除重复研究或Meta分析类文章。以15篇文献为主重点对腰麻-硬膜外联合麻醉各种用药方案麻醉效果进行分析。结果与结论:几种密度的药液均能满足髋关节置换要求。高密度及等密度的药液对于低密度的药液来讲Bromagc评分更高一些,阻滞效果也更完善一些。麻醉的起效时间根据药液的配比来讲,3g/L的罗哌卡因可能更快一些。麻醉持续时间高密度与等密度药液明显长于低密度的药液。等密度,高密度,低密度腰麻-硬膜外联合麻醉在老年髋关节置换术中的应用均是安全可靠的。

BACKGROUND：Now,anesthesia methods commonly used in the elderly include equal-density,high-density and low-density spinal-epidural anesthesia.The best anesthesia regimen can be chosen based on comparison of different proportion of spinal-epidural anesthesia.OBJECTIVE：To analyze and compare the drug regimen,onset time of anesthesia,anesthesia duration,Bormage motor blocking score among different proportion of spinal-epidural anesthesia.METHODS：A computer based search was performed to retrieve articles about spinal-epidural anesthesia for hip replacement published from 2000-01 to 2011-05 using the keywords of ＂hip replacement,combined spinal-epidural anesthesia＂ in Chinese and English.Repetitive articles or Meta analysis were excluded.Finally,15 articles were included in the result analysis.RESULTS AND CONCLUSION：These proportions of the liquid can meet the requirements of total hip replacement.The Bromagc scores of the high-density and equal-density spinal-epidural anesthesia were higher than that of the low-density anesthesia.The onset time of 3 g/L ropivacaine regimen could be faster.Duration of high-density and equal-density anesthesia was longer than that of low-density anesthesia.Equal-density,high-density and low-density spinal-epidural anesthesias are all safe and reliable in elderly hip replacement.