盐酸罗哌卡因腰硬联合麻醉对老年下肢骨折手术患者术后镇痛及不良反应影响

Effect of spinal epidural anesthesia combined with ropivacaine hydrochloride on postoperative analgesia and adverse reactions in senile patients with lower limb fracture surgery

目的下肢骨折为临床常见疾病,手术为其常见治疗方案,但受老年患者手术耐受性差等多种因素影响,需选择有效麻醉方式以促使手术顺利进行。本研究探讨盐酸罗哌卡因腰硬联合麻醉对老年下肢骨折手术患者临床应用效果与安全性。方法选择2016-02-13-2018-10-19于南阳南石医院接受下肢骨折手术的108例患者为研究对象,其中实施盐酸布比卡因腰硬联合麻醉54例患者为对照组,实施盐酸罗哌卡因腰硬联合麻醉的54例患者为观察组。比较两组阻滞效果、术后镇痛与不良反应发生情况。结果两组感觉阻滞起效时间对比,差异无统计学意义,t=0.241,P=0.810;观察组运动阻滞起效时间为(133.51±28.67)s,短于对照组的(185.32±41.06)s,t=7.603,P<0.001;最大运动阻滞时间为(21.02±2.69)min,长于对照组的(10.49±2.17)min,t=22.389,P<0.001;术后2h与2d,观察组视觉模拟评分(visual analogue scale,VAS)分别为(3.36±0.62)和(1.12±0.35)分,均低于对照组的(4.59±0.73)和(1.32±0.49)分,差异有统计学意义,t值分别为9.437和2.441,P值分别为<0.001和0.016;术后6h、12h和1d,两组VAS评分对比,差异均无统计学意义,t值分别为0.331、0.824和0.792,均P>0.05。观察组不良反应发生率为3.70%,对照组为7.41%,组间对比,差异无统计学意义,χ^2=0.177,P=0.401。结论老年下肢骨折手术患者采用盐酸罗哌卡因腰硬联合麻醉,可获取良好的阻滞效果,利于提高术后镇痛效果,且安全性较高。

OBJECTIVE Lower limb fracture is a common disease in clinic.Surgery is a common treatment.However,due to the poor tolerance of elderly patients to surgery and other factors,effective anesthesia should be selected to facilitate the smooth operation.The purpose of this study is to investigate the clinical effect and safety of ropivacaine hydrochloride combined spinal-epidural anesthesia in elderly patients undergoing lower limb fracture surgery.METHODS The patients with lower limb fracture surgery in the hospital from February 13,2016 to October 19,2018 were selected as research objects.A total of 54 patients who received combined spinal epidural anesthesia with bupivacaine hydrochloride were taken as control group,and a total of 54 patients who underwent combined spinal epidural anesthesia with ropivacaine hydrochloride were taken as observation group.The block effect,postoperative analgesia and adverse reactions were compared between two groups.RESULTS There was no statistical difference in the onset time of sensory block between two groups,t=0.241,P=0.810;The onset time of motor block in observation group was(133.51±28.67)s,shorter than that in control group(185.32±41.06)s,t=7.603,P<0.001.The maximum motor block time in observation group was(21.02±2.69)min,longer than that in control group(10.49±2.17)min,t=22.389,P<0.001;After surgery for 2 h and 2 d,the scores of visual analogue scale(VAS)in observation group were(3.36±0.62)and(1.12±0.35)points,lower than those in control group[(4.59±0.73)and(1.32±0.49)points],t values were 9.437 and 2.441,P<0.001 and0.016;After surgery for 6 h,12 hand 1 d,there was no statistical difference in the VAS scores between two groups,t values were 0.331,0.824 and 0.792,Pvalues all>0.05;There was no statistical difference in the incidence of adverse reactions between observation group(3.70%)and control group(7.41%),χ^2=0.177,P=0.401.CONCLUSION Combined spinal epidural anesthesia with ropivacaine hydrochloride in senile patients with lower limb fracture surgery can achieve better block effect,it can increase postoperative analgesia effects and achieve higher safety.