轻比重腰麻用于老年患者人工股骨头置换术疗效观察

Spinal anesthesia with hypobaric bupivacaine for patients undergoing artificial femoral head replacement

目的:观察轻比重布比卡因腰麻用于老年患者人工股骨头置换手术时的安全性和有效性。方法:选择ASAⅠ~Ⅲ级接受人工股骨头置换手术的老年患者40例,随机分为轻比重布比卡因腰麻组(D组)和重比重布比卡因腰麻组(C组),每组20例。两组患者经L3~4间隙行蛛网膜下腔穿刺,D组患肢在上,C组患肢在下,成功后分别注入0.5%重比重布比卡因局麻药和0.25%轻比重布比卡因局麻药,记录两组麻醉前(T0)、麻醉后5 min(T1)、10 min(T2)、15 min(T3)和30 min(T4)平均动脉压(MAP)和心率(HR)的变化,记录两组感觉阻滞平面达T10所需时间、改良Bromage评分达3级所需时间及术中麻醉相关并发症发生情况。结果:与T0比较,两组患者麻醉后各时间点MAP均下降,差异有统计学意义(P<0.05)。D组优于C组,差异有统计学意义(P<0.05);两组感觉阻滞平面达T10所需时间、Bromage评分达3级所需时间比较,C组快于D组,差异有统计学意义(P<0.05)。结论:在老年患者股骨头置换术中,与重比重布比卡因腰麻相比,0.25%轻比重布比卡因腰麻血流动力学更加稳定,术中麻醉相关并发症发生率更低。

Objective：To analyze the efficacy and reliability of spinal anesthesia with hypobaric bupivacaine for patients undergoing artificial femoral head replacement.Methods：Forty ASAⅠ ～ Ⅲ patients undergoing elective surgeries on artificial femoral head replacement randomly divided into spinal anesthesia with hypobaric bupivacaine group（D,n = 20） and control group（C,n = 20）.Parameters of haemodynamics were recorded and incidence rates of complication of anesthesia were calculated.Results：There was significant change in parameters of haemodynamics,complete block time and incidence rates between group C and group D（P〈0.05）.MAP significantly decreased compared to the baseline in both groups（P〈0.05）.Conclusion：In surgeries on artificial femoral head replacement,compared to spinal anesthesia with hypobaric bupivacaine fhyperbaric,spinal anesthesia with hypobaric bupivacaine was safe and effective.