摘要
目的观察高密度小剂量左布比卡因单侧蛛网膜下隙阻滞用于老年患者下肢骨科手术的临床效果和可行性。方法选择择期行下肢骨科手术的老年患者756例，按照随机数字表法分为左布比卡因组383例和布比卡因组373例。观察两组麻醉前后血流动力学变化、感觉和运动阻滞的情况。结果左布比卡因组感觉阻滞起效时间和运动阻滞起效时间分别为（5．9±1．4）、（11．7±3．0）min，均明显晚于布比卡因组的（4．2±0．3）、（9．1±3.3）min，差异有统计学意义（P〈0．05）；而左布比卡因组运动阻滞持续时间为（152．8±17．5）min，明显短于布比卡因组的（195．4±18．7）min，差异有统计学意义（P〈0．05）；左布比卡因组最高运动阻滞评分为（1．1±0．3）分，明显低于布比卡因组的（2．3±0．6）分，差异有统计学意义（P〈0．05）。两组最高感觉阻滞平面和血流动力学变化比较差异无统计学意义（P〉0．05）。结论左布比卡因麻醉效果虽略逊于布比卡因，但高密度小剂量左布比卡因单侧蛛网膜下隙阻滞因其麻醉效果确切、血流动力学稳定、感觉和运动阻滞恢复快，用于老年患者下肢骨科手术更为安全。
Objective To explore the effects and feasibility of minimal local analgesic dose of hyperbaric levobupivacaine in elderly patients undergoing unilateral spinal anesthesia during lower limb orthopedic surgery. Methods Seven hundred and fifty-six elderly patients who scheduled lower limb orthopedic surgery were assigned to levobupivacaine group （383 patients） and bupivacaine group （373 patients） by random digits table method. Haemodynamic change were monitored before, during and after anesthesia. The level and duration of sensory and motor block in each group were evaluated. Results Compared with bupivacaine group, the sensory block and motor block onset time was significantly longer in levobupivacaine group [ （5.9 ± 1.4） min vs. （4.2 ±0.3 ） min, （11.7 ± 3.0） min vs. （9.1 ± 3.3 ） min] （P 〈 0.05 ）, but the motor block duration was shorter [ （ 152.8 ± 17.5 ） min vs. （ 195.4 ± 18.7 ） rain ] （P 〈 0.05 ）. The scores of maximum motor block in levobupivacaine group was significantly lower than that in bupivacaine group [ （1.1 ± 0.3 ） rain vs. （2.3 ±0.6 ） min ] （P 〈 0.05 ）. There was no significant difference in peak sensory block and haemodynamic between two groups （P 〉 0.05 ）. Conclusions Although levobupivacaine may be less potent than bupivacaine, it may be preferred for elderly patients with lower limb surgery because of satisfactory spinal anesthesia, good haemodynamie stability and fast motor block regression.
出处
《中国医师进修杂志》
2012年第35期32-34,共3页
Chinese Journal of Postgraduates of Medicine
