不同比重布比卡因蛛网膜下腔麻醉用于高龄患者前列腺电切术的临床观察

Clinical Observation of Intraspinal Anesthesia with Different Proportion of Bupivacaine in Elderly Patients Undergoing Transurethral Prostatectomy

目的:比较不同比重布比卡因蛛网膜下腔麻醉对高龄患者前列腺电切术的麻醉效果。方法:选择60例70岁以上择期行前列腺电切术的患者,随机均分为3组。Ⅰ组为重比重布比卡因10mg(0.75%布比卡因1.3mL+10%葡萄糖0.7mL),Ⅱ组为等比重布比卡因10mg(0.5%布比卡因2mL),Ⅲ组为轻比重布比卡因10mg(0.5%布比卡因2mL+0.9%氯化钠溶液3mL)。术中持续监测心电图(ECG)、血压(BP)、心率(HR)、氧饱和度(SpO2),观察临床麻醉效果及对循环系统的影响。结果:所有患者均在蛛网膜下腔麻醉下完成手术,3组的麻醉优良率均达100.0%。阻滞起效时间、痛觉恢复时间和Bromage评分3组比较无显著性差异(P>0.05),痛觉消失时间、运动阻滞恢复时间Ⅲ组显著短于Ⅰ、Ⅱ组(P<0.05)。面罩吸氧下3组的SpO2均达到99%以上,3组比较差异无统计学意义(P>0.05)。Ⅰ、Ⅱ组在给药后5、10min出现BP下降、HR增快,与基础值和Ⅲ组比较差异均有统计学意义(P<0.05)。Ⅲ组患者血液循环稳定,麻醉效果满意。结论:高龄前列腺电切术患者应用轻比重布比卡因蛛网膜下腔麻醉,对循环系统影响小,是一种安全、有效的麻醉方法。

OBJECTIVE：To compare the intraspinal anesthesia of different proportion of bupivacaine in elderly patients with transurethral prostatectomy.METHODS：60 patients,over the age of 70 undergoing elective transurethral prostatectomy,were randomly divided into 3 groups（n=20）,i.e.hyperbaric bupivacaine 10 mg in group Ⅰ（0.75% bupivacaine 1.3 mL＋10% glucose 0.7 mL）,isobaric bupivacaine 10 mg in groupⅡ（0.5% bupivacaine 2 mL） and hypobaric bupivacaine 10 mg in group Ⅲ（0.5% bupivacaine 2 mL＋0.9% sodium chloride solution 3 mL）.The electrocardiogram（ECG）,blood pressure（BP）,heart rate（HR）,oxygen saturation（SpO2） were monitored during operation,and effect of clinical anesthesia and impact of it on circulatory system were observed.RESULTS：All patients completed surgery under intraspinal anesthesia,and the excellent rate of anesthesia in 3 groups was 100.0%;block onset time,pain recovery time and Bromage score of 3 groups had no significant difference（P0.05）.The pain disappeared and motor block recovery time of Ⅲ group were significantly shorter than those of group Ⅰ and Ⅱ（P0.05）.Using oxygen mask,the SpO2 was above 99% in 3 groups,there was no significant difference（P0.05）;5,10 min after administration,the decrease of blood pressure and the increase of heart rate were found in group Ⅰ and Ⅱ,there was significant difference,compared with baseline and group Ⅲ（P0.05）.Blood circulation of patients in group Ⅲ is stable,satisfactory anesthesia had been obtained.CONCLUSION：The intraspinal anesthesia of hypobaric bupivacaine in elderly patients with transurethral prostatectomy has little effect on the circulatory system,and it is a safe and effective method of anesthesia.