老年患者髋关节置换术中不同比重罗哌卡因腰麻临床应用比较

Comparison of clinical efficacy of different ratios of ropivacaine in spinal anesthesia for elderly patients undergoing hip arthroplasty

目的对比不同比重罗哌卡因腰麻在老年患者髋关节置换术中的疗效。方法择期行髋关节置换术老年患者90例,随机分为重比重组、轻比重组与等比重组,每组30例。重比重组使用1%罗哌卡因1.5 ml+10%葡萄糖1.5 ml行蛛网膜下隙阻滞,轻比重组使用1%罗哌卡因1.5 ml+灭菌注射用水1.5 ml行蛛网膜下隙阻滞;等比重组使用1%罗哌卡因1.5 ml+0.9%氯化钠1.5 ml行蛛网膜下隙阻滞。轻比重组及等比重组患者拟手术侧肢体(患肢)在上侧卧位,手术床头高低脚斜15°,重比重组病人患肢向下侧卧位,手术床头低脚高倾斜15°。记录三组患者感觉阻滞起效时间、运动阻滞起效时间、麻醉持续时间、感觉和运动阻滞恢复时间,用药后SBP、DBP和HR最大变化率及术后不良反应情况。结果等比重组感觉阻滞起效时间以及运动阻滞起效时间均明显长于轻比重组及重比重组(P<0.05),轻、重比重组比较差异无统计学意义(P>0.05);等比重组感觉阻滞恢复时间明显长于重比重组(P<0.05),与轻比重组比较差异无统计学意义(P>0.05);等比重组运动阻滞恢复时间明显短于轻比重组及重比重组(P<0.05);等比重组和轻比重组SBP、DBP和HR的最大变化率以及不良反应发生率均明显低于重比重组(P<0.05)。结论等比重罗哌卡因腰麻在老年患者髋关节置换术中具有较好的治疗效果,延长感觉阻滞时间、缩短运动阻滞恢复时间、血流动力学更稳定,具有更高的临床运用价值。

Objective To compare the clinical effect of three different ratios of ropivacaine in elderly patients undergoing spinal anesthesia for hip arthroplasty. Methods Ninty patients undergoing surgery were randomly divided into 3 groups（ n = 30 each） ： hyperbaric group,hypobaric group and isobaric group. Patients in hyperbaric group received ropivacaine 1. 5 ml and 10% glucose 1. 5 ml for spinal anesthesia,the patients in hypobaric group received ropivacaine 1. 5 ml and sterile distilled water 1. 5 ml for spinal anesthesia,and the patients in isobaric group received ropivacaine 1. 5 ml and 0. 9% saline diastolic for spinal anesthesia. The suffered limbs in hypobaric group and isobaric group were upward and in head-up tilt at 15° lateral position,while the suffered limbs in hyperbaric group were downward and in foot-up tilt at 15° lateral position. The onset time of sensory block and motor block,the duration of anesthesia and the recovery time of sensory block and motor block were measured,the variability of SBP,DBP,HR and postoperative adverse effects were recorded. Results The onset time of sensory block and motor block in isobaric group were significantly longer than those in hypobaric group and hyperbaric group（ P 〈0. 05）. The recovery time of sensory block in isobaric group was significantly longer than that in hyperbaric group（ P〈 0. 05）,but there was no significant difference between isobaric group and hypobaric group（ P 〉0. 05）.The recovery time of motor block in isobaric group were significantly shorter than those in hypobaric group and hyperbaric group（ P 〈0. 05）. The maximum variability of SBP,DBP,HR and postoperative adverse reaction in isobaric group and hypobaric group were lower than those in isobaric group and hyperbaric group（ P〈 0. 05）. Conclusion Isobaric ropivacaine for spinal anesthesia has a good effect in elderly patient receiving hip arthroplasty. It can prolong the sensory block time,shorten the recovery time of motor block,provide more stable hemodynamic.