小剂量罗哌卡因腰-硬联合阻滞麻醉在老年患者人工髋关节置换术中的应用价值

The Application Value of Low Dose Ropivacaine Combined Spinal Epidural Anesthesia in the Elderly Patients Undergoing Artificial Hip Replacement

目的探讨小剂量罗哌卡因腰-硬联合阻滞麻醉在老年患者人工髋关节置换术中的应用价值。方法选取2016年3月至2018年2月于上饶县第三人民医院实施人工髋关节置换术老年患者140例作为研究对象,均行腰-硬联合阻滞麻醉,按罗哌卡因使用浓度不同分为A组(0.25%罗哌卡因,70例)与B组(0.50%罗哌卡因,70例),比较两组麻醉效果及不良反应发生率。结果麻醉0.5 h后,A组平均动脉压(MAP)、动脉血氧饱和度(SpO2)、心率(HR)均低于B组,差异有统计学意义(t=9.887、25.723、21.771,P=0.000、0.000、0.000);麻醉后,A组视觉模拟评分法(VAS)评分低于B组,差异有统计学意义(t=6.297,P=0.000);术后24 h内,A组不良反应发生率为1.43%(1/70),低于B组的17.14%(12/70),差异有统计学意义(P<0.05)。结论在老年患者人工膝髋关节置换术中使用小剂量0.25%罗哌卡进行腰-硬联合阻滞麻醉对血流动力学的影响更小,镇痛效果好,并且安全性更高。

Objective To explore the application value of low-dose ropivacaine combined spinal and epidural block anesthesia in the elderly patients undergoing artificial hip replacement. Methods From March 2016 to February 2018, 140 elderly patients who underwent hip replacement in the Third People’s Hospital of Shangrao County were selected as the subjects of study. They were all given combined spinal and hard block anesthesia. According to the different concentration of ropivacaine, they were divided into group A(0.25% ropivacaine, 70 cases) and group B(0.50% ropivacaine, 70 cases). The anesthesia effect and adverse reaction rate of the two groups were compared. Results After anesthesia for 0.5 h, mean arterial pressure(MAP), arterial oxygen saturation(SpO2), heart rate(HR) in A group were lower than those in B group, and the difference was statistically significant(t=9.887, 25.723, 21.771, P=0.000, 0.000, 0.000);After anesthesia, visual analog scale(VAS) in A group was lower than that in B group, and the difference was statistically significant(t=6.297, P=0.000);During 24 h after surgery, the incidence of adverse reactions in group A was 1.43%(1/70), which was lower than 17.14%(12/70) in group B(P<0.05). Conclusion The use of low-dose 0.25% ropivaca for lumbar-scleral block anesthesia in elderly patients undergoing artificial knee and hip replacement has a smaller effect on hemodynamics, better analgesia, and greater safety.