85岁以上超高龄患者髋关节置换术罗哌卡因腰麻适宜浓度的探讨

Suitable concentration of Ropivacaine for spinal anesthesia in super-aged( over 85-year-old) patients undergoing hip arthroplasty

目的观察轻比密等容量不同浓度罗哌卡因腰麻用于85岁以上超高龄患者髋关节置换术的l临床效果及安全性。方法选取拟行髋部手术的85岁以上超高龄患者75例，采用随机数字表法随机分成Ⅰ、Ⅱ、Ⅲ组，每组25例。I组：用0．2％罗哌卡因；Ⅱ组：用0．25％罗哌卡因；Ⅲ组：用0．3％罗哌卡因。各组均使用2ml。于L3-4间隙穿刺，腰穿针回抽脑脊液通畅后注入轻比密罗哌卡因。观察镇痛起效时间、运动阻滞起效时间、最高痛觉阻滞平面、麻醉持续时间、最大运动阻滞程度、痛觉及运动恢复时间、Bromage评分及用药后的MAP、HR变化。结果Ⅰ组感觉阻滞起效时间差异无统计学意义，最高锐痛觉阻滞平面0．3％浓度组最高（P〈0．05），麻醉持续时间Ⅲ组和Ⅱ组长于I组（P〈0．05）；运动阻滞起效时间Ⅲ组短于Ⅰ组和Ⅱ组（P〈0．05）。Bromage评分〈3分的例数，Ⅲ组〉Ⅱ组〉Ⅰ组（JP〈0．05）。下肢运动恢复时间随着罗哌卡因浓度的增加而逐渐延长，组间差异有统计学意义（P〈0．05）。结论85岁以上超高龄老年患者髋关节置换术麻醉适宜腰麻浓度和剂量为0．25％罗哌卡因2ml，在轻比密、同等容量前提下较0．2％罗哌卡因有效，较0．3％罗哌卡因安全。

Objective To observe the light specific gravity of different concentrations of Ropivacaine applied to spinal anesthesia for the clinical efficacy and safety in elderly patients over the age of 85 years undergoing hip arthroplasty. Methods According to ran- dom number table, a total of 75 elderly patients over 85 years scheduled to undergo hip surgery were divided into three groups （ n = 25/group） , i.e. Group I , Group ]I and Group ]]Igiven Ropivacaine at eoncetration of O. 2% , 0.25% and O. 3% , respective- ly. Ropivacaine （2 ml） was injected into the cerebrospinal fluid smoothly at L3 4 gap via lumbar needle after withdrawing. The indi- cators, including analgesic onset time, motor block onset time, maximal pain block level, duration of anesthesia, maximal degree of motor block, and pain and sports recovery time, MAP, HR changes after Bromage score and medication, were observed. Results The difference in sensitive anesthesia onset time was not significant among the three groups. Maximal pain block level was the highest in Group Ⅲ （P 〈0.05）. Duration of anesthesia was higher in GroupⅡ or Ⅲ than in Group Ⅰ （P 〈 0.05 ）. Motor block onset time was earlier in Group Ⅲ than in Group Ⅱ or Ⅰ （P 〈 0.05）. As for the number of the patient with Bromage score under 3, Group m was more than Group Ⅱ and Group Ⅱ more than Group Ⅰ （ P 〈 0.05 ）. Lower extremity motor recovery time was gradually extended with the increase in the concentration of Ropivacaine, and the difference among the groups was significant （ P 〈 0.05 ）. Conclusion The most suitable concentration is 0.25% of Ropivacaine with a volume of 2 ml for the elderly pa- tients over 85-year-old undergoing hip arthroplasty. With light specific gravity, it is more effective than 0.2% and safer than 0.3% of isometric Ropivacaine.