重比重与轻比重罗哌卡因单侧腰硬联合麻醉用于老年髋关节手术的对比研究

Comparative research of hyperbaric and hypobaric ropivacaine in unilateral combined spinal epidural anesthesia for senile hip joint surgery

目的比较重比重与轻比重盐酸罗哌卡因注射液单侧腰硬联合麻醉（CSEA）用于老年髋关节手术中的效果及其安全性。方法 60例ASAⅡ～Ⅲ级、择期行髋关节置换手术的老年患者,随机分为A组（轻比重腰麻组）和B组（重比重腰麻组）,每组30例。观察记录两组麻醉效果,麻醉期间收缩压（SBP）、舒张压（DBP）、心率（HR）、血氧饱和度（Sp O2）的数值,麻醉起效时间,阻滞完善时间,麻醉合并症及不良反应,用Bromage法评定运动神经阻滞情况。结果所有患者麻醉效果满意。两组组间和组内血流动力学及组间麻醉起效时间、阻滞完善时间及麻醉合并症、不良反应发生率比较差异均无统计学意义（P〉0.05）。术毕A组Bromage评分分级明显低于B组,差异有统计学意义（P〈0.01）。结论两种比重的盐酸罗哌卡因注射液单侧腰硬联合阻滞方法均可安全有效地用于老年髋关节手术患者,而轻比重CSEA术毕对老年患者运动神经阻滞较轻,术后双下肢保持了良好的运动功能,有利于患者术后早日康复。

Objective To compare effects and safety between hyperbaric and hypobaric ropivacaine in unilateral combined spinal epidural anesthesia（CSEA） for senile hip joint surgery. Methods A total of 60 ASA Ⅱ~Ⅲ senile patients receiving hip joint surgery were randomly divided into group A（hypobaric spinal anesthesia group） and group B（hyperbaric spinal anesthesia group）, with 30 cases in each group. Observation and record were made on anesthetic effect, systolic blood pressure（SBP）, diastolic blood pressure（DBP）, heart rate（HR）, oxyhemoglobin saturation（Sp O2） during anesthesia, anesthesia onset time, block complete time, anesthesia complications and adverse reactions in the two groups. Their motor nerve block status was evaluated by Bromage method. Results All the patients received satisfactory anesthetic effects. There were no statistically significant differences of haemodynamics, anesthesia onset time, block complete time, and anesthesia complications between the two groups and in each group（P〉0.05）. After operation, group A had much lower Bromage score than group B, and their difference had statistical significance（P〈0.01）. Conclusion Hyperbaric and hypobaric ropivacaine in unilateral combined spinal epidural anesthesia can be both applied for effective and safe senile hip joint surgery. Hypobaric CSEA provides slight motor nerve block and good double lower limbs motor function after operation. It is beneficial for early rehabilitation.