0.33%不同容积等比重罗哌卡因蛛网膜下腔阻滞在老年股骨颈骨折中的应用

Application of 0.33% Different Volume Isospecific Ropivacaine Subarachnoid Block in the Treatment of Femoral Neck Fracture in the Elderly

目的探讨0.33%不同容积等比重罗哌卡因蛛网膜下腔阻滞在老年股骨胫骨折患者中的应用方法及效果。方法选择河源市中医院2017年1月—2018年6月期间收治的股骨颈骨折老年患者60例,采用随机数字表法将其分为观察组和对照组,每组各30例。两组患者均采用脑脊液将1%盐酸罗哌卡因注射液稀释为0.33%(1.0 ml罗哌卡因+2.0脑脊液),观察组与对照组分别予以2.2 ml和1.8 ml,对比两组患者T0注药前、T1注药3 min、T2注药5 min、T3注药10 min、T4注药15 min、T5注药20 min以及T6注药30 min的MAP平均动脉压、HR心率与感觉阻滞平面高度,比较两组患者麻醉有效率、术中及术后出现的恶心呕吐、寒颤、低血压等并发症。结果观察组患者麻醉有效率为100%,明显高于对照组的43.3%(P<0.05)。观察组患者T1~T5段和对照组T1~T6段HR与T0段相比明显增快(P<0.05),T6段观察组患者恢复正常。两组患者MAP从T0段~T4段均持续降低,T4~T6持续增高。在感觉阻滞平面方面则持续下降,两组差异无统计学意义(P>0.05)。并发症方面,观察组患者出现2例寒颤和1例栓塞,发生率为10%,对照组共出现9例,发生率为30%,高于观察组(P<0.05)。结论 0.33%等比重罗哌卡因2.2 ml比1.8 ml对股骨颈骨折患者有更好的麻醉效果,安全性更高,循环稳定性更好,具有很高的应用价值。

Objective To investigate the application and effect of 0.33% isospecific ropivacaine block in elderly patients with fem-oral and tibial fractures.Methods60 elderly patients with femoral neck fracture in the hospital from January,2017 to June,2018 were randomly divided into observation group(n=30)and control group(n=30). The patients in both groups were diluted with 1% ropi-vacaine hydrochloride injection to 0.33%(1.0 ml ropivacaine+2.0 cerebrospinal fluid). The observation group and control group weretreated with 2.2 ml and 1.8 ml respectively. MAP mean arterial pressure,HR heart rate and sensory block level height before injectionT0,injection for 3 min T1,5 min T2,0 min T3,15 min T4,20 min T5 and 30 min T6 were compared between the two groups.Postoperative and intraoperative nausea and vomiting,shivering,hypotension and other complications were compared.ResultsTheeffective rate of anesthesia in the observation group was 100%,which was significantly higher than that in the control group(43.3%,P<0.05). The HR of T1~T5 segment in the observation group and T1~T6 segment in the control group were significantly higher thanthose in the T0 segmen(tP<0.05). Patients of the observation group returned to normal in T6. In both groups,MAP decreased continu-ously from T0 to T4,and increased continuously from T4 to T6. There was no significant difference in sensory block level between thetwo groups. There were 2 cases of shivering and 1 case of embolism in the observation group(10%)and 9 cases in the control group(30%),which were higher than those in the observation group(P<0.05).Conclusion0.33% isogravity ropivacaine 2.2 ml has betteranesthetic effect,higher safety,better circulation stability and higher application value than 1.8 ml in the treatment of femoral neck fracture.