不同比重罗哌卡因单侧蛛网膜下腔阻滞麻醉在髋关节置换术中的应用

Application of Ropivacaine with different proportion for Unilateral spinal Anesthesia in hip replacement operation

目的：评价不同比重罗哌卡因单侧蛛网膜下腔阻滞麻醉在髋关节置换术中应用。方法：选择拟行人工髋关节置换术的患者60例,ASAⅠ或Ⅱ级,随机均分为0.4%罗哌卡因轻比重组（L组）和重比重组（W组）,每组30例。测定并记录麻醉前和麻醉后1、3、5、10、20 min MAP、HR,最高阻滞平面、感觉阻滞起效时间、运动阻滞起效时间、Bromage评分、患肢完全阻滞和麻黄碱使用例数。结果：与麻醉前相比,W组麻醉后5~20 min MAP明显降低,HR明显增快,差异有统计学意义（P〈0.01）,并且同时间点MAP明显低于、HR明显快于L组,差异有统计学意义（P〈0.01）;与L组比较,W组感觉阻滞起效时间明显缩短,差异有统计学意义（P〈0.01）;Bromage评分及麻黄碱使用率升高,差异有统计学意义（P〈0.05或P〈0.01）。结论：0.4%罗哌卡因5 ml单侧蛛网膜下腔阻滞麻醉用于髋关节置换术能取得良好的麻醉效果,与重比重液相比,使用轻比重液血液动力学更加平稳,是该类手术麻醉的较佳选择。

Objective To evaluate application of Ropivacaine with different proportion for Unilateral spinal Anesthesia in hip replacement surgery. Method sixty patients ASAⅠ ~ Ⅱscheduled for hip replacement surgery were randomly divided into two groups（ n = 30） ： 0. 4% hypobaric ropivacaine（ Group L） and hyperbaric ropivacaine（ Group W）. The changes in MAP、HR before and after anesthesia 1、3、5、10、20min were recorded. The highest plane of analgesia、the onset time of sensation block、the onset time of motor block、Bromage scores、Limb completely sensory block and Ephedrine use cases were recorded. Results After anesthesia in 5 ~ 20 min,MAP decreased and HR increased obviously in group W compared with pre- anesthesia,the difference was statistically significant（ P〈0. 01）; and the same time,MAP was significantly lower and HR obviously faster than that of the group L,the difference was statistically significant（ P〈0. 01）. Compared with L group,the sensory block onset time was significantly shortened,the difference was statistically significant（ P〈0. 01）,the Bromage score and ephedrine use cases increased in group W,the difference was statistically significant（ P〈0. 05 or P〈0. 01）. Conclusion The 0. 4% ropivacaine 5 ml for unilateral spinal anesthesia in hip replacement surgery,both hypobaric and hyperbaric liquids can achieve good quality of anesthesia,but the use of hypobaric liquid hemodynamics more stable. So it is a good choice for this kind of operation.