布比卡因蛛网膜下腔-硬膜外对老年下肢骨折麻醉效果影响

The Effect of Spinal Epidural Anesthesia Combined With Low Dose Bupivacaine on Circulatory Function and Anesthetic in Elderly Patients With Lower Limb Fracture

目的分析采用小剂量布比卡因蛛网膜下腔-硬膜外联合麻醉的方式对老年下肢骨折患者循环功能的影响以及麻醉效果。方法遵循盲选原则在本院于2015年6月~2016年6月所收治的老年下肢骨折患者中选取80例作为研究对象,将其均分为观察组与对照组,每组各40例。观察组术中采用小剂量布比卡因蛛网膜下腔-硬膜外联合麻醉,对照组单纯给予连续硬膜外麻。比较两组患者麻醉效果以及循环功能的影响。结果治疗中,观察组麻醉药物使用量为（5.41±1.24）mg,对照组为（34.51±16.41）mg,观察组低于对照组,差异具有统计学意义（P〈0.05）。观察组麻醉起效用时为（46.24±10.39）s,而对照组为（345.14±54.84）s。观察组短于对照组,差异具有统计学意义（P〈0.05）。在改良Bromage评分上,观察组平均得分为（1.15±0.47）分,对照组为（2.84±0.94）分,观察组低于对照组,差异具有统计学意义（P〈0.05）。且麻醉后,观察组仅2例患者出现心动过缓,4例出现低血压,而对照组对应为8例、14例,差异具有统计学意义（P〈0.05）。结论与连续硬膜外麻相比,小剂量布比卡因蛛网膜下腔-硬膜外联合麻醉可有效减少术中对麻醉药的使用量,能将药物对循环功能的影响降至最低,帮助患者尽快恢复。

Objective To analyze the effect of the circulation function of patients with small dose bupivacaine combined spinal epidural anesthesia is a way for elderly lower limb fracture and the anesthetic effect. Methods According to the principle of selection method blind in our hospital from June 2015 to June 2016 were 80 cases of the elderly lower limb fracture as the main object of observation were selected and divided into the observation group and control group,40 cases in each group. Observation group was treated with small dose bupivacaine subarachnoid epidural anesthesia during the operation. Control group were treated with continuous epidural anesthesia. The effect of two groups were compared with anesthesia effect and circulation function. Results During treatment,the use of narcotic drugs in the observation group was（5.41 ± 1.24） mg, the control group was（34.51 ± 16.41） mg,the observation group was lower than the control group, the difference was statistically significant（P〈0.05）. The effect of anesthesia in the observation group was（46.24 ± 10.39）s,while the control group was（345.14±54.84）s. The observation group was shorter than the control group, the difference was statistically significant（P〈0.05）. On the modified Bromage score, the average score of the observation group was（1.15±0.47）,and the control group was（2.84±0.94）,the observation group was lower than the control group,the difference was statistically significant（P〈0.05）. After anesthesia,the observation group only 2 patients with bradycardia, hypotension occurred in 4 cases,while the control group was 8 cases and the other 14 cases,the difference was statistically significant（P〈0.05）. Conclusion Compared with continuous epidural anesthesia,small dose bupivacaine combined with epidural anesthesia can effectively reduce the amount of anesthetics used during operation,to minimize the impact of drugs on circulatory function,to help patients recover as soon as possible.