微量泵持续给药硬膜外麻醉用于高龄患者全髋关节置换术的临床研究

Clinical study on micropump continuous drug administration epidural anesthesia in elderly patients with total hip replacement

目的比较连续硬膜外麻醉不同给药方式在高龄患者行全髋关节置换术的应用效果。方法 112例美国麻醉师协会(ASA)Ⅱ~Ⅲ级择期行全髋关节置换术的老年患者,男55例,女57例,年龄75~91岁。将患者分为A、B两组各56例。穿刺点L2~L3,对患者实施连续硬膜外穿刺成功后注入2%利多卡因3mL,根据麻醉平面追加2%利多卡因3~5mL,A组患者调节麻醉平面达T10且固定后根据患者情况硬膜外连续输注2%利多卡因3~5mL/h,B组患者调节麻醉平面达T10且固定后根据患者情况术中硬膜外分次注入2%利多卡因3~5mL/h。两组患者术中必要时给予血管活性药物多巴胺。记录两组入室、注药后30min、切皮、手术1h、术毕的平均动脉压(MAP)、心率(HR)及脉搏血氧饱和度(SPO2)。记录两组麻醉平面、麻醉药物用量、麻醉效果及多巴胺总用量。结果两组患者硬膜外给药后血压均有明显下降,B组术中追加药物后血压较A组下降明显(P<0.05)。A组较B组麻醉平面更加平稳(P<0.01)且麻醉药物用量明显减少(P<0.05)。A组患者术中多巴胺总用量明显少于B组(P<0.05)。结论连续硬膜外麻醉中微量泵持续给药较间断单次给药对患者血流动力学的影响小,在不影响麻醉效果的情况下平面更加平稳且明显减少麻醉药物的用量,有利于维持循环稳定,提高围术期安全性。

Objective To compare the application effects of different drug administration modes under continuous epidural anesthesia in elderly patients undergoing total hip replacement. Methods One hundred and twelve ASA II-IIIelderly patientl un- dergoing elective total hip replacement, 55 males and 57 females,aged 75-91 years old,were randomly divided into the group A and B,56 cases in each group. After continuous epidural puncture success at L2--L3,the test dose of 2 % lidocaine 3 mL was injected, according the anesthesia plane,additional 2 % lidocaine 3-- mL was injected,the group A adjusted the anesthesia plane to T10 ,after fixation,epidural continuous infusion of 2 % lddocaine 3-5 mL/h was performed according to the patientrs condition; the group B adjusted the anesthesia plane to T1c, after fixation,according to patient＇s condition epidural injection of 2% lidocaine 3-5 mL/h was injected by several times. The two groups were given vasoactive drugs dopamine when necessary during operation. Mean arterial pressure（MAP） ,heart rate （t-IR） and pulse oxygen saturation （SPOz） at entering the operation room, 30 min after medication in- jection, skin incision, postoperative 1 h and end of operation were recorded in the two groups. The anesthesia plane,anesthetic drug dosage,anesthesia effect and total dosage of dopamine were recorded in the two groups. Results Blood pressure after epidural drug administration in the two groups were significantly reduced, while the blood pressure after intraoperatively administrating additional drug in the group B was significantly decreased compared with the group A（P〈0.05）. The.anesthesia plane in the group A was more stable than that in the group B （P〈0.01）, moreover the dosage of anesthetic drug was decreased significantly （P〈0.05）. The in traoperative total amount of dopamine in the group A was obviously less than that in the group B （P〈0. 05）. Conclusion Micropump continuous drug administration during continuous epidural anaesthesia has little influence on the patient＇s hemodynam- ics than discontinuous single drug administration. In the condition without affecting the anesthesia effect, the anesthesia plane is more stable.the anesthesia drug dose can be significantly decreased, which is conducive to maintain the circulation stable and in- crease perioperative safety.