老年患者下肢手术腰硬联合麻醉用药比较

目的：通过对65岁以上老年患者下肢手术不同剂量的腰硬联合麻醉（CsEA）期间的麻醉效果，对循环呼吸功能变化的观察比较，选择适宜的麻醉用药方案。方法：80例AsAⅡ级～Ⅲ级，择期髋关节手术36例，男25例，女11例，股骨下段骨折20例，膝关节手术24例；年龄65～90岁，体重45～80kg。选L2～3间隙硬膜外穿刺，头端置管，用药分两组：A组40例，0．2％罗哌卡因5～10rag腰麻；（65～70岁10mg，70～75岁7mg，75～80岁6mg，90岁以上5mg）B组40例病人，10％葡萄糖1ml＋0．75％布比卡因12．5mg，腰麻联合麻醉药物剂量随年龄递增而递减，并记录麻醉效果：入室前及腰麻后15min，硬膜外给药30min术中最低值血压，HR，Sp02，麻黄碱和阿托品及辅助用药情况。结果：二组患者麻醉效果均满意，麻醉平面〉T8者A组最少，B组最多，血压HR和SpOz，A组各时点与基础值比较无统计学意义；麻黄碱使用例数最少；术后无头痛。结论：严格控制CSEA中腰麻药物的浓度，比较剂量并适时与硬膜外阻滞用药联合，可以避免腰麻对心血管和呼吸的干扰，低浓度小剂量轻比重罗哌卡因CSEA，其用药量少，镇痛满意，对循环呼吸干扰甚微，麻醉消退快，术后能早期活动。并发症少，是适合于高龄手术患者安全、可靠的一种麻醉方法。

Objective 65 years of age and older patients with lower limb surgery of different doses of spinal epidural anesthesia （CSEA） during the anesthetic effect, the observation of changes in the circulatory and respiratory functions, the appropriate choice of anesthetic regimen. Methods~ 80 cases of ASA grade n Ill level elective hip surgery in 36 cases, 25 males and 11 females, distal femur fractures in 20 cases, 24 cases of knee surgery; age 65 to 90 years old, weig- hing 45 ~ 80kg. Choose the L2 3 gap epidural puncture, the head--end catheter, medication divided into two groups; A group of 40 eases, 0.2~/~ ropivacaine 5 ~ 10mg spinal anesthesia; （65 to 70--year--old 10mg, 70 to 75--year--old 7mg 75 to 80--year--old 6mg, more than 90 years old, 5rag） in Group B 40 pa- tients, 10% glucose to lml -~0.75~/oo bupivacaine 12.5rag, spinal anesthesia joint anesthetic dose with age increment and decrement, and record the narcotic effect： burglary waist linen for 15 minutes, the minimum value of blood pressure in the epidural administration 30rain surgery, HR, SpO2, ephedrine and atro- pine, and adjuvant situation. Results： The two groups of patients with anesthetic effect were satisfied with the level of anesthesia T8 A group of at least the highest in group B, blood pressure, HR and the SpO2 in group A at each time point compared with baseline values not statistically significant ephedrine use the number of cases at least surgery after no headache. Conclusion.- strict control of drug concentration in spinal anesthesia, CSEA, comparative dose and timely and epidural anesthesia medication joint can avoid spinal anesthesia on the cardiovascular and respiratory interference, light proportion of the low concentration of small doses of ropivacaine in CSEA, and their medication less analgesia, minimal interference on the circulatory and respiratory, anesthesia subsided quickly after early activities. Fewer complications, and is suitable in elderly surgical patients safe, reliable and a narcotic.