两种比重布比卡因腰硬联合麻醉在老年患者下肢手术中的应用价值探讨

Investigation on application value of two kinds of specific gravity of bupivacaine in combined spinal-epidural anesthesia for elderly patients with lower limb surgery

目的探讨适合老年患者下肢手术腰硬联合麻醉布比卡因的比重。方法 124例行下肢手术老年患者,根据注射布比卡因的比重分为重比重组和轻比重组,各62例。均行腰硬联合麻醉,重比重组患者以0.2 ml/s的速度注射0.75%布比卡因1 ml与10%葡萄糖1 ml所配成的重比重药液,轻比重组患者以0.2 ml/s的速度注射0.75%布比卡因1 ml与注射用水1 ml所配成的轻比重药液。比较两组的麻醉效果。结果重比重组的麻醉显效时间(2.6±1.2)min快于轻比重组(3.9±1.3)min,麻醉持续时间(332±27)min长于轻比重组(242±16)min,差异有统计学意义(P<0.05);两组患者的麻醉优良率及恶心、呕吐、寒战、头痛并发症比较差异无统计学意义(P>0.05)。重比重组低血压发生率高于轻比重组,差异具有统计学意义(P<0.05)。结论重比重布比卡因更适合应用于老年人下肢手术的腰硬联合麻醉。

Objective To investigate the suitable specific gravity of bupivacaine in combined spinalepidural anesthesia for elderly patients with lower limb surgery. Methods A total of 124 elderly patients with lower limb surgery were divided by specific gravity of bupivacaine into high specific gravity group and low specific gravity group, with 62 cases in each group. Both groups received combined spinal-epidural anesthesia. The high specific gravity group received injection of high specific gravity liquid of 0.75% bupivacaine 1 ml and 10% glucose 1 ml at the rate of 0.2ml/s, and the low specific gravity group received low specific gravity liquid of 0.75% bupivacaine 1 ml and 10% water for injection 1 ml at the rate of 0.2ml/s. The anesthetic effect into groups was compared. Results The high specific gravity group had shorter anesthetic effective time as（2.6±1.2） min than（3.9±1.3） min in low specific gravity group, and longer duration of anesthesia as（332±27） min than（242±16） min in low specific gravity group. Their difference had statistical significance（P〈0.05）. Both groups had no statistically significant difference in excellent rate of anesthesia, and complications of nausea, vomiting, chills and headache（P〈0.05）. The high specific gravity group had higher incidence of hypotension than the low specific gravity group, and the difference had statistical significance（P〈0.05）. Conclusion High specific gravity of bupivacaine is more suitable in combined spinal-epidural anesthesia for elderly patients with lower limb surgery.