腰硬联合麻醉在老年患者人工股骨头置换术中的临床应用

Clinical application of combined spinal-epidural anesthesia in elderly patients with hemiarthroplasty

目的观察0.5%轻比重罗哌卡因腰硬联合麻醉在老年患者人工股骨头置换术中的有效性及安全性。方法选择40例ASAⅡ-Ⅲ级择期行人工股骨头置换术的老年患者,随机分为2组:罗哌卡因(R组)和丁哌卡因(B组),观察2组患者麻醉前和注药后5 min,10 min,20 min,30 min各时间点收缩压(SBP)、舒张压(DBP)、心率(HR)。记录感觉阻滞起效时间、平面固定时间、感觉阻滞时间、运动阻滞起效时间、达最大运动阻滞时间、运动阻滞的持续时间。记录术中使用麻黄碱、阿托品以及发生不良反应的例数。结果 R组的SBP、DBP、HR在注药后观察的各时点较麻醉前无显著变化,而B组的SBP,DBP,HR在注药后10 min、20 min、30 min与麻醉前基础值和同时点R组的相比显著降低,R组的感觉阻滞时间和运动阻滞持续时间明显短于B组,R组中使用麻黄碱、阿托品的例数较B组少,寒战和恶心呕吐的例数也较B组少。结论 0.5%罗哌卡因腰硬联合麻醉用于老年患者人工股骨头置换术是安全有效的。

Objective To observe the efficacy and safety of 0.5% hypobaric ropivacaine combined spinal-epidural anesthesia surgery in elderly patients with hemiarthroplasty. Methods Forty elderly patients with ASA Ⅱ -Ⅲ elective hemiarthroplasty were sdected and randomly divid- ed into ropivacaine group （group R） and bupivacaine （group B）. Systolic blood pressure （SBP）, di- astolic blood pressure （DBP）, heart rate （HR） before anesthesia and 5 min, 10 min, 20 min, 30 min after anesthesia in the two groups were observed. Sensory block onset time, the plane fixed time, the sensory block, motor block onset time, up to the maximum motor blockade, duration of motor block were recorded were recorded. The adverse reactions were recorded as well. Results No significant changes of SBP, DBP and HR were observed at each time point in group R after anes- thesia. 10 min, 20 min, 30 min after anesthesia, SBP, DBP and HR in group B showed significant decrease compared with group R. Sensory block and motor block duration in group R were signifi- cantly shorter than those in group B. The number of ephedrine and atropine in group R was less than that in group B. The number of patients with chills and nausea and vomiting was less than that in group B. Conclusion 0.5 % ropivacaine combined spinal-epidural anesthesia with for hemiarthro- plasty elderly patients is safe and effective.