小剂量罗哌卡因麻醉在老年膝髋关节置换中的价值

Value of low dose ropivacaine anesthesia in elderly knee and hip replacement

目的探讨小剂量罗哌卡因麻醉在老年膝髋关节置换中的价值。方法入选我院收治老年膝髋关节置换术患者92例,按照随机表法分为A组与B组,各46例。A组注入0. 25%罗哌卡因,用0. 75%罗哌卡因1 mL+注射用水2 mL配制而成; B组注入0. 50%罗哌卡因,用0. 75%罗哌卡因1 mL+注射用水1 mL配制而成。比较2组麻醉持续时间、运动恢复时间和感觉恢复时间、健侧下肢运动神经阻滞情况、心率和平均动脉压(MAP)变化,及药物不良反应发生情况。结果 A组和B组的麻醉持续时间分别为(85. 48±6. 71),(103. 29±10. 39)min,运动恢复时间分别为(106. 37±10. 90),(127. 21±14. 36) min,感觉恢复时间分别为(160. 93±13. 42),(195. 68±15. 46) min,差异均有统计学意义(均P <0. 05)。A组健侧下肢运动神经阻滞Ⅰ级(23. 91%)多于B组(6. 52%),Ⅲ级(26. 09%)少于B组(52. 17%),差异均有统计学意义(均P <0. 05)。A组麻醉5,10,30 min心率和MAP低于B组(P <0. 05)。A组药物不良反应发生率(13. 04%)低于B组(34. 78%),差异有统计学意义(P <0. 05)。结论 0. 25%浓度罗哌卡因在老年膝髋关节置换中效果优于0. 50%浓度罗哌卡因,且药物不良反应发生率低。

Objective To investigate the value of low dose ropivacaine anesthesia in the elderly knee and hip replacement.Methods Ninety-two elderly patients with knee and hip replacement were randomly divided into A group and B group,each group 46 cases.A group was injected with 0.25% ropivacaine(0.75% ropivacaine 1mL + water for injection 2 mL),B group was injected with 0.50% ropivacaine(0.75% ropivacaine 1mL + water for injection 1mL).The duration of anesthesia,recovery time and feel the recovery time,the situation of contralateral limb,heart rate and mean arterial pressure(MAP)changes,and the incidence of adverse drug reactions in two groups were observed.Results The duration of anesthesia in group A and B were(85.48±6.71),(103.29±10.39)min, the recovery time of movement were(106.37±10.90),(127.21±14.36)min,the recovery time of sensation were(160.93±13.42),(195.68±15.46)min,all with significant difference(allP<0.05).In A group,motor nerve block of the contralateral lower extremity in grade Ⅰ(23.91%)was more than that in group B(6.52%)and grade Ⅲ(26.09%)was less than that in group B(52.17%),with significant difference(P<0.05).In group A,heart rate and mean artery presssure(MAP)were lower than those in Bgroup at 5,10 and 30 min after anesthesia(P<0.05).The incidence of adverse drug reactions in group A(13.04%)was lower than that in group B(34.78%,P < 0.05).Conclusion 0.25% ropivacaine is better than0.50% ropivacaine in the elderly knee joint replacement,and has less adverse drug reactions.