罗哌卡因腰硬联合麻醉在下肢骨折手术中的应用

APPLICATION OF ROPIVACAINE COMBINED SPINAL-EPIDURAL ANESTHESIA IN LOWER LIMB FRACTURE SURGERY

目的:探讨0.75%罗哌卡因腰-硬联合麻醉(CSEA)在下肢骨折手术中的临床效果。方法:100例下肢骨折手术患者随机分为罗哌卡因组(A组)和布比卡因组(B组),每组50例患者,两组均采用CSEA,A组病人注入0.75%罗哌卡因2ml、B组病人注入0.75%布比卡因2ml。观察两组患者感觉和运动阻滞效果、术中麻醉效果、麻醉后不良反应及血流动力学指标的变化。结果:A组感觉阻滞恢复时间、运动阻滞恢复时间明显短于B组,A组感觉阻滞最大阻滞时间、最大维持时间,运动阻滞起效时间、最大运动阻滞时间均长于B组,差异有统计学意义(P<0.05)。A组不良反应发生率明显低于B组,差异具有统计学意义(P<0.05,P<0.01)。两组舒张压(DBP)、心率(HR)、血氧饱和度(SpO2)给药前后无显著差异;A组收缩压(SBP)给药前后无显著差异,B组收缩压(SBP)给药后5min-30min下降明显(P<0.05)。结论:0.75%罗哌卡因腰-硬联合麻醉可安全应用于下肢骨折手术,且无明显不良反应及并发症,有利于术后恢复。

Objective：To investigate the clinical effects of combining 0.75% ropivacaine and spinal-epidural anesthesia （CSEA） on lower limb fracture surgery.Methods：100 lower limb fracture patients were randomly divided into 2 groups （n=50）： ropivacaine group （group A） and bupivacaine group （group B）. Patients in these 2 groups were all adopted CSEA, but patients ha group A were injected 2ml 0.75% ropivacaine, patients in group B were injected 2ml 0.75% bupivacaine. The sensory block effects, motor block effects, anaesthetic effects, adverse reactions and hemodynamics indexes of patients in 2 groups were observed.Results：The sensory block recovery time, motor block recovery time of patients in group A were obviously shorter than that of patients in group B （P〈 0.05）. The biggest block time and biggest lasting time of sensory block, the onset time and biggest block time of motor block of group A were obviously longer than group B （P〈 0.05）. The adverse reactions rate of group A was obviously lower than group B （P〈 0.05,P〈 0.01）. The DBP, HR and SpO2 of patients in 2 groups before and after injecting anesthetics had no obvious differences. The SBP of patients in group A before and after injecting anesthetics had no obvious differences; the SBP of patients in group B decreased obviously 5min-30min after injecting anesthetics （P〈 0.05）.Conclusions：Combined 0.75% ropivacaine and CSEA is safe in lower limb fracture surgery, no obvious adverse reactions and complications, and is better for postoperative recovery.