小剂量布比卡因腰硬联合麻醉对高龄全髋置换术患者血流动力学的影响

Effect of small dose bupivacaine for combined spinal epidural anesthesia on hemodynamics in elderly patients with total hip replacement

目的观察小剂量布比卡因腰硬联合麻醉（CSEA）对高龄全髋置换术患者血流动力学的影响作用。方法选取择期拟行全髋置换术的高龄患者50例,美国麻醉医师协会（ASA）分级Ⅱ或Ⅲ级,年龄均为70岁以上,性别不限。采用随机数字表法,将患者随机分为2组,CSEA组（C组）和硬膜外麻醉组（E组）,每组25例。C组穿刺成功后,向蛛网膜下腔缓慢注入0.5%布比卡因等比重液1.5~2mL,再置入硬膜外导管。E组注入2%利多卡因试验量3mL,根据麻醉平面追加2%利多卡因5~8mL,调节麻醉平面T8以下。记录麻醉起效时间和麻醉平面,监测血压、心率、脉搏和血氧饱和度变化情况。结果 C组麻醉起效时间、平面固定时间较E组明显缩短,差异有统计学意义（P〈0.01）。与C组对应值比较,E组收缩压（SBP）在T3~4时均降低（P〈0.05）,与基础值比较,C组SBP、舒张压（DBP）、血液流变学（HR）在T2时均降低（P〈0.05）,E组SBP、DBP在T2~4时均降低（P〈0.05或0.01）。结论小剂量布比卡因CSEA在高龄全髋置换术中具有用药少、起效快、镇痛完善、肌松效果好,维持血流动力学稳定的优点,是一种安全可靠的麻醉方法,值得临床采用。

Objective To investigate the effect of low dose bupivacaine for combined spinal epidural anesthesia （CSEA） on hemodynamics in elderly patients with total hip replacement. Methods Fifty ASA Ⅱ orⅢ elderly patients of both sexes, aged above 70 years undergoing total hip replacement were randomly allocated into two groups （n= 25 each） ：the CSEA group（group C） ariel the epidtural anesthesia group（group E）. After successful puncture, 0.5% bupi- vacaine isobaric solution 1.5--2 mL was injected slowly to subarachnoid cavity in the group C, then the epidural cath eter was placed. In the group E,2% lidoeaine 3mL was injected as a test dose,according to the level of anesthesia for additional 2% lidocaine 5-SmL adjusting the level of anesthesia under Ts. The onset time of anesthesia and the level of anesthesia, blood pressure, heart rate and pulse oxygen saturation were recorded. Results The onset time and level fixed time of anesthesia in the group C were shorter than those in the group E,the differences were statistically sig nificant （P〈0.01）. The SBP at T3 4 in the group E was decreased than that in the group C（P〈0.05）. Compared with the baseline,SBP,DBP and HR at T2 in the group C and SBP,DBP at T2-4 in the group E were decreased（P〈0.05 or P〈0.01）. Conclusion CSEA with low dose bupivacaine has many advantages of less medication,rapid ac- tion, perfect analgesia, good muscle relaxation and hemodynamic stability in the elderly patients with total hip replace- ment, which is a safe and reliable method of anesthesia and deserves to be clinincally used.