蛛网膜下腔辅用地塞米松对高龄下肢手术麻醉的影响

Effect of Dexamethasone Used in Subarachnoid Space on Gerontal Patients＇ Lower Extremity Surgery Anesthesia

【目的】探讨蛛网膜下腔辅用地塞米松对高龄患者下肢手术麻醉的影响。【方法】选取150例本院收治的需接受下肢手术的老年患者为研究对象，随机将其分为三组，每组各50例。A组；蛛网膜下腔注射含20μg芬太尼及4mg布比卡因的2mL生理盐水；B组：注射含5mg地塞米松粉剂、20μg芬太尼及4mg布比卡因的2mL生理盐水，并将2mL生理盐水通过静脉注射注入A，B组患者体内；C组：蛛网膜下腔注射含20μg芬太尼及4mg布比卡因的2mL生理盐水，并将溶有5mg地塞米松的2mL生理盐水通过静脉注射注入患者体内。分析比较麻醉前后三组患者的心率（HR）及平均动脉压（MAP）及感觉阻滞起效及消退的时间和术后不良反应的发生情况。【结果】三组患者的术中出血量、术中补液量、手术时间、HR、MAP、最高阻滞平面、起效时间、达最高平面所需时间、运动阻滞时间及术后不良反应发生情况相比较差异无显著性（均P〉0．05）。而B组患者的感觉阻滞时间显著长于A组及C组（均P〈0．01）。【结论】将地塞米松注射入老年患者蛛网膜下腔，可使术中芬太尼联合小剂量布比卡因在腰椎麻醉中发挥的感觉阻滞作用延长。

[Objective] To explore the effect of dexamethasone used in subarachnoid space on gerontal patients＇ lower extremity surgery anesthesia. [Methods]The 150 gerontal patients who need lower extremity surgeries were selected as research subjects. The research subjects were randomly divided into 3 groups. The first group received 2mL normal saline （including 20μg fentanyl and 4mg bupivacaine） and 2mL normal saline by intravenous injection. The second group received 2mL normal saline （including 5mg hexadecadrol, 20μg fentanyl, and 4mg bupivacaine）, and 2mL normal saline by intravenous injection. The third group received 2mL normal saline （including 20μg fentanyl and 4mg bupivacaine）, and 2mL normal saline （including 5mg hexadecadrol） by intravenous injection. The HR, mean arterial pressure （MAP）, time of motor and sensory retardant and untoward effects were compared between the three groups before and after anesthesia. [Results]There weren＇t obvious differences in amount of bleeding and resus fluid during the operation, time of operation, HR, MAP, the highest block plane, onset time, the time needed for top plane, motion block time or untoward effect between the three groups （all P〈0.05）. However, duration of sensory block of the second group was significantly longer than the other two groups （all P〈0.001） . [Conclusion]Dexamethasone used in subarachnoid space can make the time of sensory retardation caused by fentanyl combined with small dose bupivacaine in gerontal patients＇ lower extremity surgery anesthesia longer.