不同剂量罗哌卡因联合利多卡因腰硬联合麻醉在老年妇女子宫切除术中的麻醉效果

Anesthetic effects of combined different doses of ropivacaine and lidocaine for lumbar epidural anesthesia in elderly patients undergoing hysterectomy

目的 探讨不同剂量罗哌卡因联合利多卡因腰硬联合麻醉对老年子宫切除术患者的麻醉效果,并进行统计分析. 方法 选择2009年4月至2012年6月本院收治的子宫切除老年患者100例,随机分为低剂量组和高剂量组,每组50例.低剂量组给予罗哌卡因10 mg联合利多卡因,高剂量组给予罗哌卡因15 mg联合利多卡因,均采取腰硬联合麻醉,观察两组的麻醉效果. 结果 高剂量组的感觉阻滞起效时间显著短于低剂量组[（159±21）s和（225±23）s,t=3.412,P＜0.05],最高平面出现时间显著短于低剂量组[（7.3±1.3）min和（9.2±1.5）min,t=2.877,P＜0.05],最高平面维持时间也显著长于低剂量组[（57.3±8.1）min和（45.3±7.2）min,t=2.623,P＜0.05]；高剂量组的运动阻滞起效时间明显短于低剂量组[（4.3±1.2）min和（6.9±1.3）min,t=3.109,P＜0.05],而运动阻滞维持时间显著长于低剂量组[（161±16）min和（133±14）min,t=2.793,P＜0.05]；2组改良Bromage评分差异无统计学意义（P＞0.05）,高剂量组麻醉效果优良率为94％,低剂量组为80％（x2=4.33,P＜0.05）；2组的不良反应发生率比较,差异无统计学意义（P＞0.05）. 结论 采用15 mg剂量的罗哌卡因联合利多卡因腰硬联合麻醉对老年妇女子宫切除术的麻醉效果较好,可作为临床实践参考.

Objective To explore and analyze the anesthetic effects of different doses of ropivacaine combined with lidocaine for epidural anesthesia in elderly patients undergoing hysterectomy.Methods A total of 100 elderly patients who required hysterectomy in our hospital from April 2009 to June 2012 were randomly divided into the low dose group and the high dose group （n=50,each group）.The low dose group was given 10 mg ropivacaine combined with lidocaine for lumbar epidural anesthesia,and the high dose group was given 15 mg ropivacaine combined with lidocaine for lumbar epidural anesthesia.The anesthetic effects in the two groups were observed.Results The onset time of sensory block and highest plane time were significantly shorter in high dose group than in low dose group [（159±21） s vs.（225±23） s,（7.3±1.3） min vs.（9.2±1.5） min,respectively,t=3.412 and 2.877,both P〈0.05）].The maintenance time of highest plane was significantly longer in high dose group than in low dose group [（57.3±8.1） min vs.（45.3±7.2）min,t=2.623,P〈0.05].The onset time of movement block was shorter in high-dose group than in low dose group[（4.3±1.2） min vs.（6.9±1.3） min,t=3.109,P〈0.05],while the maintenance time of movement was longer in high-dose group than in low dose group[（161 ± 16） min vs.（133 ±14） min,t=2.793,P〈0.05].There were no significant differences in modified Bromage Score between the two groups （P〉0.05）.The excellent anesthetic effect was significantly higher in high dose group than in low dose group （90% vs.80%,x2 =4.33,P〈0.05）.There were no significant differences in the incidence of adverse reactions between the two groups （P〉0.05）.Conclusions The application of 15 mg ropivacaine combined with lidocaine has a better anesthetic effect for lumbar epidural anesthesia in elderly patients undergoing hysterectomy.It can provide a reference for the clinical practice.