轻比重布比卡因蛛网膜下腔麻醉联合脊椎麻醉对行防旋股骨近端髓内钉术老年患者的麻醉效果及影响

Efficacy of subarachnoid anesthesia with light specific gravity bupivacaine combined with spinal anesthesia for elderly patients undergoing proximal femoral nail antirotation

目的 探究轻比重布比卡因蛛网膜下腔麻醉联合脊椎麻醉对行防旋股骨近端髓内钉(PFNA)术老年患者的麻醉效果及其对循环呼吸系统的影响。方法 选取2015年8月至2018年8月在青海省人民医院行PFNA术的60例老年患者为研究对象。分为2组:轻比重组和重比重组,每组30例。重比重组使用3ml含0.5%布比卡因的葡萄糖溶液麻醉,轻比重组使用6ml含0.25%布比卡因的蒸馏水溶液麻醉。检测并比较2组麻醉前(T0)、麻醉平面固定后(T1)、用药后5min(T2)、15min(T3)、30min(T4)和60min(T5)的镇静程度及循环呼吸系统变化。使用简易精神状态量表(MMSE)评估患者认知情况。比较2组麻醉效果和不良反应发生情况。采用SPSS20.0软件进行数据处理。结果 2组患者麻醉起效时间、T0~T5时间点的Ramsay评分基本一致(P>0.05)。与重比重组相比,轻比重组中麻醉阻滞平面≥T10者的比例(20.00%vs43.33%)、以及麻黄碱(3.33%vs43.33%)和阿托品(6.67%vs36.67%)的使用率均显著降低(P<0.05)。与T0时间点相比,2组患者T2~T5时间点的平均动脉压(MAP)、心率、收缩压、舒张压、呼吸频率和脉搏血氧饱和度(SpO2)均有降低趋势。与轻比重组比较,重比重组患者T1~T5时间点的MAP和SpO2显著降低(P<0.05),T2~T5时间点的心率、收缩压、舒张压和呼吸频率显著降低(P<0.05)。轻比重组患者麻醉后24h的MMSE评分显著高于重比重组[(24.14±2.14)vs(26.83±2.34)分,P<0.05]。轻比重组认知功能障碍发生率(3.33%vs16.67%)和不良反应发生率(23.33%vs46.67%)均显著低于重比重组(P<0.05)。结论 对行PFNA术的老年患者采用轻比重布比卡因蛛网膜下腔麻醉联合脊椎麻醉阻滞能够获得满意的麻醉效果,且对循环呼吸系统影响较小、安全性较高,值得在临床推广。

Objective To investigate the anesthetic effect of subarachnoid anesthesia of light specific gravity bupivacaine combined with spinal anesthesia and its effect on circulatory and respiratory systems in the elderly patients undergoing proximal femoral nail antirotation (PFNA). Methods Sixty elderly patients who underwent PFNA surgery in our hospital from August 2015 to August 2018 were selected as subjects. They were randomly divided into 2 groups: light specific gravity group and heavy specific gravity group, with 30 cases in each group. Distilled water solution (6 ml) containing 0.25% bupivacaine was administered in the former group, and glucose solution (3 ml) containing 0.5% bupivacaine was administered in the latter group. The sedation levels and changes in circulatory and respiratory systems were detected and compared between the 2 groups before anesthesia (T 0), after anesthesia plane fixation (T 1), and in 5(T 2), 15(T 3), 30(T 4) and 60 min (T 5) after administration. Patients′ cognitive status was assessed with mini- mental state examination (MMSE) scale. The anesthetic effects and adverse reactions of the 2 groups were compared. Data processing was performed using SPSS statistics 20.0. Results The Ramsay scores at onset time of anesthesia and the T 0-T 5 time points were almost similar between the 2 groups ( P >0.05). The light specific gravity group had lower percentages of the patients with anesthesia block plane ≥ T 10 (20.00% vs 43.33%), and reduced usages of ephedrine (3.33% vs 43.33%) and atropine (6.67% vs 36.67%) when compared with the heavy specific gravity group ( P <0.05 ). Compared with the T 0 time point, the mean arterial pressure (MAP), heart rate, systolic pressure, diastolic pressure, respiratory rate, and pulse oximetry (SpO 2) of the 2 groups were in a trend of decrease at the T 2-T 5 time points. MAP and SpO 2 were significantly lower in T 1-T 5 time points, and heart rate, systolic blood pressure, diastolic blood pressure and respiratory rate were also obviously lower at T 2-T 5 time points in the heavy than the light specific gravity group ( P <0.05 ). The MMSE score at 24 h after anesthesia was significantly higher in the light than the heavy specific gravity group [(24.14±2.14) vs (26.83±2.34), P <0.05]. The incidences of cognitive dysfunction (3.33% vs 16.67%) and adverse reactions (23.33% vs 46.67%) in the light specific gravity group were significantly lower than those of heavy specific gravity group ( P <0.05). Conclusion Satisfactory anesthetic effect is achieved in the elderly patients undergoing PFNA with combination of subarachnoid anesthesia of light specific gravity bupivacaine and spinal anesthesia. It has good safety and less effect on the circulatory and respiratory systems, and is worthy of further application in clinical practice.