不同质量浓度甲磺酸罗哌卡因腰麻在高龄患者下肢手术中的应用

Application of different concentrations of ropivacaine mesylate proportion of spinal anesthesia in elderly patients with lower limb operation

目的:比较不同质量浓度的甲磺酸罗哌卡因腰麻用于高龄患者下肢手术时的安全性和有效性。方法:将108例行下肢手术的高龄患者随机分为低质量浓度重相对密度组(Ⅰ组)、低质量浓度轻相对密度组(Ⅱ组)和高质量浓度重相对密度组(Ⅲ组),每组36例。3组患者均行腰—硬联合麻醉,并给予同等剂量的腰麻液甲磺酸罗哌卡因8.94 mg。监测记录3组患者的阻滞平面,运动阻滞程度,麻醉效果,麻醉前和麻醉后5 min、15 min、30 min的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2),并发症以及不良反应等。结果:3组患者感觉阻滞效果优良率均达到100%;运动阻滞Bromage评分达3分的例数分别为26、25、36,3组差异均具有统计学意义(P<0.05)。血流动力学组间比较:注药后15 min 3组MAP分别为(114.86±13.65)、(113.56±16.54)、(75.21±15.65)mmHg;HR分别为(94.51±16.53)、(94.65±16.12)、(112.65±23.56)次·min-1,Ⅰ、Ⅱ组与Ⅲ组差异均具有统计学意义(P<0.05),Ⅰ、Ⅱ组间差异无统计学意义(P>0.05)。血流动力学组内比较:Ⅰ、Ⅱ组与相应麻醉前比较差异均无统计学意义(P>0.05),Ⅲ组注药前与注药15 min后MAP分别为(116.53±15.32)和(75.21±15.65)mmHg,差异有统计学意义(P<0.05);Ⅲ组的不良反应明显多于Ⅰ、Ⅱ组(P<0.05)。结论:低质量浓度甲磺酸罗哌卡因腰—硬联合麻醉应用于高龄患者下肢手术,血流动力学平稳,麻醉效果满意,副作用少,安全可行。

Objective：To compare the proportion of different concentration ropivacaine mesylate spinal anesthesia safety and effect for elderly patients in lower limb operation. Methods： 108 cases elderly patients with lower limb operation were randomly divided into three groups（ n = 36）： group Ⅰ（ with low concentration heavy specific gravity）,group Ⅱ（ with low concentration and light weight）,group Ⅲ（ with high concentration and heavy weight）,all of them were treated with combined spinal epidural anesthesia and infused with the same dose of ropivacaine 8. 94 mg. Patients’ s block plane,the degree of motor block,anesthesia effect,average artery pressure（MAP）,heart rate（HR）,pulse oxygen saturation（SpO2）,and the complications and adverse reaction befor and after anesthesia 5 min,15 min and 30 min,were recorded. Results： The effective rate of feeling block in the three groups of patients reached 100%. The cases of the three groups motion block Bromage score of 3 were 26,25,36.There were differences between group Ⅰ,Ⅱ and Ⅲ group significantly（P 〈 0. 05）. MAP after injection of 15 min in the three groups were（114. 86 ± 13. 65）,（113. 56 ± 16. 54）,（75. 21 ± 15. 65） mmHg. HR after injection of15 min in three groups were（94. 51 ± 16. 53）,（94. 65 ± 16. 12）,（112. 65 ± 23. 56） bpm. Differences in groupⅠ,Ⅱ and group Ⅲ were significant（P 〈 0. 05）,while differences between groupⅠ and Ⅱwere not significant（P 〉0.05）. Group Ⅰ,Ⅱ compared with pre anesthesia had no difference（P 〉0.05）. Group Ⅲ before injection and after injection of 15 min MAP were（116. 53 ± 15. 32） and（75. 21 ± 15. 65） mmHg respectively（P 〈 0. 05）.There were more adverse reaction in group Ⅲ than group Ⅰ,Ⅱ（ P 〈 0. 05）. Conclusion： Low concentration of ropivacaine in combined spinal epidural anesthesia in elderly patients’ lower limb operation has stable hemodynamics,satisfactory anesthesia effect and less side effects,and is safe and feasible.