老年膝髋关节置换应用罗哌卡因腰椎硬膜外联合麻醉:置换后不良反应率低

Combined spinal-epidural anesthesia with ropicavaine in elderly patients undergoing knee or hip arthroplasty: low incidence of postoperative side effects

背景:老年人下肢关节手术常选用全麻或者连续硬膜外麻醉。单纯的硬膜外麻醉效果确切,容易控制,肌肉松弛效果较好,但是麻醉诱导时间相对较长,对控制膀胱腹膜反折处疼痛不理想,而且循环系统干扰受到腰麻过程中影响相对较大。目的:探讨在老年下肢骨关节置换过程中罗哌卡因腰椎硬膜外联合应用的麻醉效果。方法:纳入菏泽市立医院在2013年9月至2014年11月收治的下肢人工关节置换的老年患者90例,其中膝关节置换52例,髋关节置换38例,随机分为2组,每组45例。对照组采用连续硬膜外麻醉,观察组采用罗哌卡因腰椎硬膜外联合麻醉。观察并比较两组患者在置换过程中的生命体征、麻醉起效时间、局麻药诱导量、镇痛效果及置换后不良反应。结果与结论:置换过程中对照组患者在心率、脉搏、动脉血氧饱和度均低于观察组,观察组患者置换过程中的基本生命体征更加稳定,两组对比差异有显著性意义(P<0.05)。观察组患者麻醉起效时间、局麻药诱导量明显优于对照组,两组对比差异有极显著性意义(P<0.01)。对照组镇痛效果优秀率为67%,低于观察组89%,两组比较差异有显著性意义(P<0.05)。对照组患者置换后出现呕吐10例、呼吸困难4例,不良反应发生率为31%;观察组出现呕吐3例,呼吸困难2例,不良反应发生率为11%,对照组不良反应发生率显著高于观察组(P<0.05)。提示罗哌卡因腰椎硬膜外联合麻醉在老年下肢骨关节置换过程中镇痛效果好,麻醉起效时间短,局麻药诱导量低,置换后不良反应发生率低。

BACKGROUND： General anesthesia or continuous epidural anesthesia can be commonly selected for lower limb joint surgery in the elderly. The effect of epidural anesthesia is precise, and can be easily controlled. The effect of muscle relaxation is good. However, the time of anesthesia induction is relatively long, and it is not ideal in the control of pain in the visceral peritoneum reflection region. Moreover, circulatory system interference can be greatly affected by lumbar anesthesia. OBJECTIVE： To evaluate the effects of combined spinal-epidural anesthesia with ropicavaine in elderly patients undergoing lower limb arthroplasty. METHODS： Ninety patients undergoing lower limb arthroplasty admitted to Heze Municipal Hospital from September 2013 to November 2014 were chosen and were equally and randomly assigned to two groups, including 52 cases of knee replacement and 38 cases of hip replacement. Patients in the control group received continuous epidural anesthesia. Patients in the observation group received combined spinal-epidural anesthesia with ropicavaine. Vital signs, onset time of anesthesia, drug consumption, analgesic effect and postoperative side effects were observed and compared in both groups. RESULTS AND CONCLUSION： Heart rate, pulse, and arterial oxygen saturation were significantly lower in the control group than in the observation group. Vital signs in the observation group were more stable, and the significant difference was detected between the two groups（P〈0.05）. Onset time of anesthesia and drug consumption were significantly better in the observation group than in the control group, showing very significant differences between the two groups（P〈0.01）. The excellent and good rate of analgesic effects was lower in the control group（67%） than in the observation group（89%）, which showed significant differences between the two groups（P〈0.05）. In the control group, vomiting appeared in 10 cases and dyspnea appeared in 4 cases, with an incidence of side effect of 31%. In the observation group, vomiting appeared in 3 cases and dyspnea in 2 cases, with the incidence of side effects of 11%. The incidence of side effect was significantly higher in the control group than in the observation group（P〈0.05）. These data indicate that combined spinal-epidural anesthesia with ropicavaine showed good analgesic effect in elderly patients receiving lower limb arthroplasty. The onset time of anesthesia was short. Drug consumption was low. The incidence of side effects was low.