不同剂量轻比重布比卡因对高龄患者单侧蛛网膜下隙阻滞特征的影响

Effect of hypobaric bupivacaine at different doses on the characteristics of unilateral spinal block in the elderly patients

目的探讨不同剂量轻比重布比卡因对高龄患者单侧蛛网膜下隙阻滞(单侧腰麻)阻滞特征的影响。方法 90例高龄患者随机等分为Ⅰ、Ⅱ和Ⅲ组,分别采用4.5、6.0和7.5 mg的0.3%布比卡因进行单侧腰麻。观察3组感觉及运动阻滞起效和持效时间、单侧腰麻的比率、麻醉失败率和血压等情况。结果 (1)Ⅱ组和Ⅲ组的感觉和运动阻滞起效均快于Ⅰ组(P<0.05);(2)Ⅲ组感觉和运动阻滞持效时间最长,Ⅱ组次之,Ⅰ组最短(P<0.05);(3)Ⅰ组单侧腰麻的比率最高,Ⅱ组次之,Ⅲ组最低(P<0.05);(4)Ⅰ组麻醉失败率最高(P<0.05);(5)自注药后至维持侧卧体位20 min内,3组血压均无异常改变,但变仰卧位后Ⅲ组出现血压下降(P<0.05)。结论 (1)高龄患者行轻比重布比卡因单侧腰麻,剂量较小则感觉和运动阻滞起效更慢,且持效更短、麻醉失败率更高,但单侧腰麻的比率更高;(2)高龄患者单侧腰麻用0.3%轻比重布比卡因6.0 mg安全可靠。

Objective To explore the effect of hypobaric bupivacaine at different doses on the characteristics of unilateral spinal block（unilateral spinal anesthesia） in the elderly patients. Methods Ninety old patients were randomly divided into Group Ⅰ, Ⅱ and Ⅲ, receiving the administration with 4.5, 6.0 and 7.5 mg of 0.3% hypobaric bupivacaine for unilateral spinal anesthesia, respectively. The onset time and the lasting time for sensory and motor block, the success rate of unilateral spinal anesthesia, the failure rate of anesthesia and blood pressure of the three groups were observed. Results The onset for sensory and motor block in Group Ⅱ and Ⅲ was faster than that in Group Ⅰ（P〈0.05）;（2） The lasting time for sensory and motor block in Group Ⅲ was the longest, followed by Group Ⅱ, and then Group Ⅰ（P〈0.05）;（3） The successful rate of unilateral spinal anesthesia in Group Ⅰ was the highest, followed by Group Ⅱ, and then Group Ⅲ（P〈0.05）;（4） The failure rate of anesthesia in Group Ⅰ was the highest（P〈0.05）;（5） There was no abnormal change in the pressure of the three groups within 20 min of maintaining lateral position since drug injection, but Group Ⅲ had decreased pressure after changing to supine position（P〈0.05）. Conclusion （1） For the treatment of unilateral spinal anesthesia in the elderly with hypobaric bupivacaine, a smaller dose has a slower onset for sensory and motor block and shorting duration and higher failure rate of anesthesia, but has a higher successful rate for unilateral spinal anesthesia;（2） 6.0 mg of 0.3% hypobaric bupivacaine is safe and reliable for the treatment of unilateral spinal in the elderly patients.