小剂量轻比重布比卡因单侧腰麻在高龄患者全髋置换术中的应用

Clinical application of small dose hypobaric bupivacaine for unilateral spinal anesthesia in elderly patients with total hip arthroplasty

目的观察两种不同小剂量轻比重布比卡因在高龄患者全髋关节置换术中单侧腰麻的麻醉效果及安全性。方法随机选择2013年6月至2014年6月择期行全髋关节置换术的高龄患者30例,按照随机数表法均分为Ⅰ、Ⅱ两组,每组各15例。两组患者均行蛛网膜下腔穿刺,Ⅰ组患者注入0.25%布比卡因轻比重腰麻液2.0 ml,Ⅱ组患者注入0.375%布比卡因轻比重腰麻液2.0 ml。比较两组患者麻醉前（t0）,给药后1分钟（t1）、5分钟（t2）、15分钟（t3）、20分钟（t4）、30分钟（t5）、l小时（t6）及术毕（t7）的平均动脉压（MAP）、心率（HR）和脉搏血氧饱和度（Sp O2）的变化情况。观察两组患者镇痛起效时间、运动阻滞起效时间、麻醉持续时间、最大Bromage评分、最高痛觉阻滞平面、痛觉及运动恢复时间、完全阻滞的患者比例及不良反应发生情况。结果不同时间点两组患者MAP、HR、Sp O2水平组间比较差异均无显著性（P〉0.05）。Ⅰ组患者t3~t6时间点的MAP水平均较t0时间点降低,差异有显著性（P〈0.05）,Ⅱ组患者t2~t7时间点的MAP水平均较t0时间点降低,差异有显著性（P〈0.05）,两组患者其他各时间点HR、Sp O2水平组内比较差异均无显著性（P〉0.05）。两组患者患侧镇痛起效时间、完全阻滞患者比例及最高痛觉阻滞平面比较差异均无显著性（P〉0.05）。Ⅱ组患者运动阻滞起效时间显著短于Ⅰ组,最高Bromage评分明显高于Ⅰ组,麻醉持续时间、痛觉和运动恢复时间均明显长于Ⅰ组,差异均具有显著性（P〈0.05）。两组患者健侧下肢的痛觉和运动功能未出现明显阻滞。两组患者术后均未发生头痛、恶心、呕吐、尿潴留等不良反应。结论两种不同小剂量轻比重布比卡因单侧腰麻用于高龄患者股骨头置换术,均可达到完善的镇痛效果,其中5.0 mg布比卡因单侧腰麻阻滞时间更短、术后患肢运动恢复更快,值得临床推广应用。

Objective To observe the efficacy and safety of two different small doses hypobaric bupivacaine for unilateral spinal anesthesia in elderly patients undergoing total hip replacement surgery. Method From June 2013 to June 2014, 30 elderly patients scheduling for elective total hip arthroplasty were randomly divided into group Ⅰ and group Ⅱ, 15 cases in each group. Patients in both groups were received spinal anesthesia, patients in group Ⅰ were given intrathecal administration of 0.25% bupivacaine hypobaric spinal fluid 2.0 ml, and patients in group Ⅱ were given 0.375% bupivacaine hypobaric spinal fluid 2.0 ml. MAP, HR, and Sp O2 were observed at different time including pre-anesthesia（t0）, 1 minute after medication（t1）, 5 minutes after medication（t2）, 15 minutes after medication（t3）, 20 minutes after medication（t4）, 30 minutes after medication（t5）, 1 hour after medication（t6） and after operation（t7）. Postoperative motor block onset time, analgesic onset time, duration of anesthesia, the maximum degree of motor block, block plane maximum pain, pain and exercise recovery time, and the proportion of patients completely blocked adverse reactions were recorded after treatment. Result There were no significant differences in MAP, HR, and Sp O2 fluctuate at different times between the two groups（P〉0.05）. In group Ⅰ, MAP at t3~ t6 was lower than that at t0（P〈0.05）, but HR, Sp O2 at different times had no significant differences（P〉0.05）. In group Ⅱ, MAP at t2~ t7 was lower than that at t0（P〈0.05）, but HR, Sp O2 at different times had no significant differences（P〉0.05）. Analgesic onset time, block and the highest proportion of patients with complete sensory block plane contrast also had no significant difference between the two groups（P〉0.05）. Motor block onset time in group Ⅱ was shorter than that in group Ⅰ（P〈0.05）, but duration of anesthesia, the maximum Bromage score, pain, and recovery time sports in group Ⅱ were longer than those in group Ⅰ（P〈0.05）. Pain and motor function of healthy lower extremity in both groups were not blocked obviously. There were no headache, nausea, vomiting, uroschesis and other adverse effects in both groups. Conclusion Both the two different low doses hypobaric bupivacaine can reach the perfect analgesic effect for elderly patients with femoral arthroplasty during unilateral spinal anesthesia. 5.0 mg bupivacaine has a shorter time unilateral blockade, faster intraoperative recovery after limb movement and worthy of promotion.