轻比重左旋布比卡因单侧腰麻在超高龄患者下肢手术中的应用研究

The application of light specific gravity Levebupivacaine used in unilateral spinal anesthesia subject to the super-aged patients with lower extremity surgery

目的旨在分析和研究轻比重左旋布比卡因单侧腰麻在超高龄患者下肢手术中的安全性及临床效果。方法收集于本院治疗拟行人工股骨头置换术且ASAⅡ～Ⅲ级的超高龄患者90例,随机分为左旋布比卡因组(治疗组)和布比卡因组(对照组)各45例,采用腰硬联合阻滞(CSEA)方法于L2-3或L3-4间隙分别向蛛网膜下腔注射0.4%轻比重左旋布比卡因溶液3 mL和0.4%轻比重布比卡因溶液3 mL,观察并记录患者麻醉后血压及心率参数变化、感觉和运动阻滞参数、Bromage评分、视觉模拟评分(VAS)、不良反应及术后并发症等情况。结果麻醉效果对照组优36例,良9例,治疗组优40例,良5例,两组优良率均为100%;治疗组感觉恢复时间和运动恢复时间与对照组比较,差异有统计学意义(P<0.05);对照组出现低血压8例(17.78%),治疗组3例(6.67%),两组比较差异有统计学意义(P<0.05)。结论轻比重左旋布比卡因应用于超高龄患者下肢手术麻醉效果满意且不良反应较少,值得推广。

Objective To study the safety and clinical effectiveness of light specific gravity Levebupivacaine used in unilateral spinal anesthesia subject to the super-aged patients with lower extremity surgery.Methods 90 patients in our hospital who underwent hemiarthroplasty and ASA Ⅱ-Ⅲ class super-aged were collected,and randomly divided into Levebupivacaine group（treatment group） of 45 cases and Bupivacaine group（control group） of 45 cases.Spinal anesthesia was performed from the L2-3 or L3-4 in terspace in all patients,Bupivacaine group was injected 0.4% Bupivacaine 3 mL,Levebupivacaine group was injected 0.4% light specific gravity Levebupivacaine 3 mL.The changes in blood pressure,heart rate,sensory,motor block parameters,Bromage score and visual analogue scale（VAS）,adverse reactions and postoperative complications of the patients were observed and recorded.Results Anesthetic effect of the control group were excellent in 36 cases,good in 9 cases,the treatment group were excellent in 40 cases,good in 5 cases,satisfaction rates were both 100%;the sensory recovery time and exercise recovery time of two groups were statistically significant compared.The difference between treatment group and control group in recovery time of feel and the recovery time of sports were statistical significance（P 〈 0.05）.6 cases（17.14%） of hypotension were happened in control group,2 cases（5.17%） were happened in treatment group,there were statistically significant between two groups.Conclusion Light specific gravity Levobupivacaine used in unilateral spinal anesthesia subject to the super-aged patients with lower extremity surgery is satisfaction and safety,which is worthing promoted