罗哌卡因复合舒芬太尼腰麻在老年患者的应用

Application of spinal anesthesia with ropivacaine combined with sufentanil in the elderly

目的观察罗哌卡因复合舒芬太尼腰麻用于老年患者的麻醉效果。方法腰麻下行下肢手术老年(65-81岁)患者75例随机均分为三组。腰麻药物:A组,罗哌卡因15mg;B组,罗哌卡因10mg;C组,罗哌卡因10mg+舒芬太尼5μg。记录注药前后MAP和HR变化、神经阻滞效果、术后镇痛维持时间和不良反应。结果腰麻给药后,A组MAP明显低于麻醉前和B、C组(P<0.05);C组MAP下降比A组轻(P<0.05)。C组术后镇痛维持时间与A组相仿,明显长于B组(P<0.05)。与B、C组比较,A组感觉阻滞最高平面高,Bromage肌力评级高,运动神经阻滞持续时间长,术后尿潴留病例多(P<0.05)。结论罗哌卡因10mg复合舒芬太尼5μg腰麻,效果确切,血流动力学稳定,不良反应少,是老年患者腰麻的良好选择。

Objective To observe the outcomes of spinal anesthesia with ropivacaine combined with sufentanil in the elderly. Methods Spinal anesthesia was performed in 75 patients, aged 65-81 years old and undergoing selective lower limb surgery, who were equally randomized into three groups. The anasthetic drugs for spinal anesthesia were ropivacaine 15 mg in group A, ropivacaine 10 mg in group B and ropivacaine 10 mg plus sufentanil 5 μg in group C. The changes of MAP and HR were monitored before and in 20 rain after subarachnoid administration. The outcomes of nerve blockade, postoperative analgesia time and complications were recorded. Results After subarachnoid administration, MAP in group A was significantly lower than that before and that in groups of B and C （P〈0. 05）,which in group C was not decreased significantly. The postoperative analgesia time in group C was similar to that in group A, but longer than that in group B（P〈0. 05）. Compared to groups of B and C, the highest block plane was higher, Bromage grade was higher with longer motor blockade, and the cases with postoperative urinary retention were more in group A （P〈0. 05）. Conclusion Spinal anesthesia with ropivacaine 10 mg combined with sufentanil 5μg can provide a sufficient nerve blockade with stable circulation and Jess postoperative adverse responses, which is a good choice for the elderly undergoing lower extremity surgery.