椎管内麻醉不同阻滞平面对高龄全髋关节置换术患者术中血液动力学稳定性影响的探讨

An exploratory study on influence of combined spinal and epidural anesthesia at different anesthetic levels on stability of hemodynamics in elderly patients undergoing total hip arthroplasty

目的观察腰麻联合硬膜外麻醉不同阻滞平面对全髋关节置换术患者术中血液动力学变化的影响。方法随机选择全髋关节置换手术病人39例;所有实施手术病人行腰麻联合硬膜外麻醉。麻醉方法:选择L2～3间隙穿刺,腰麻药物使用重比重0.5%罗哌卡因,硬膜外腔向头端置管。观察不同麻醉平面(T10、T8、T6～7)手术过程中不同时间血液动力学变化。结果①不同麻醉平面病人组一般情况,包括年龄、体质量、性别、ASA评分、心血管系统并发症及手术、麻醉时间无统计学差异;②各组组内的术前与麻醉后各时间点平均动脉压值比较差异有统计学意义(P<0.05)。③T10组麻醉后,各手术时间点的平均动脉压与其它两组的数据比较有显著变化改变,其中T6-7组对平均动脉压影响最大(P<0.05)。④呼吸及脉搏各组间及组内比较无统计学差异(P>0.05)。结论全髋关节置换术,椎管内麻醉平面控制在T10水平,对患者血液动力学影响最小,尤其对有心血管系统合并症者是一种安全的麻醉控制方法。

Objective To observe changes of hemodynamics caused by combined spinal and epidural anesthesia （CSEA） at different anesthetic levels during total hip arthroplasty （THA）. Methods Thirty -nine patients were randomly selected to perform THA under CSEA. The puncture site was at the space between second and third lumbar vertebrae. The spinal anesthesia was performed with 0.5% ropivacalne and a cath- eter was left in epidural space towards the head. Patients were allocated into group Tl0, Ts , and T6 -7 according to anesthetic levels. Changes in hemodynamics and rates of respiration of patients in each group were observed at different time points during operation. Results No significant difference had been found among age, body weight, sex, ASA classification, cardiovascular complications, anesthetic duration and operating time between each group. Significant difference in mean arterial blood pressure was found between the period before and after anesthesia in each group （ P 〈0.05 ）. More significant changes in mean arterial blood pressure were found in group T8 and group T6 -7 than group T10, and the most significant change in mean arterial blood pressure had been found in group T6 - 7 （ P 〈 0.05 ）. No significant change was found in pulse rate and rate of respiration in patients of each group （ P 〉 0. 05）. Conclusion CSEA at T10 anesthetic level for THA causes less changes in hemodynamics and it is a safe method especially for elderly patients with cardiovascular complications.