小剂量不同浓度罗哌卡因蛛网膜下腔麻醉在老年髋关节置换术中的应用效果

Effect of Low Dose Ropivacaine Subarachnoid Anesthesia on Hip Arthroplasty in the Elderly

目的分析老年髋关节置换术中小剂量不同浓度罗哌卡因蛛网膜下腔麻醉的应用效果。方法选取我院2016年2月至2019年3月收治的106例老年髋关节置换术患者为研究对象,按照随机数字表法分为甲组与乙组,每组53例。甲、乙两组患者分别于蛛网膜下腔注入0.50%、0.25%的罗哌卡因,对比两组患者在不同时间点平均动脉压(MAP)、心率(HR)的变化情况、手术侧下肢运动神经阻滞程度、感觉恢复时间、运动恢复时间、麻醉持续时间以及不良反应发生情况。结果乙组患者手术侧下肢运动神经阻滞Ⅰ级、Ⅱ级患者构成比分别为24.53%、58.49%,均高于甲组,Ⅲ级患者构成比为16.98%,低于甲组,差异有统计学意义(χ^2=7.3611、4.5725、17.8898,P <0.05);与甲组对比,乙组患者感觉恢复时间、运动恢复时间、麻醉持续时间更短,差异有统计学意义(t=8.6326、10.2628、12.3698,P <0.05);甲组患者的不良反应发生率为22.64%,乙组为7.55%,差异有统计学意义(χ^2=4.7111,P <0.05)。结论在老年髋关节置换术中,运用小剂量0.25%的罗哌卡因进行蛛网膜下腔麻醉的效果优于0.50%的罗哌卡因,且用药安全性高。

Objective To analyze the effect of low dose ropivacaine subarachnoid anesthesia in hip arthroplasty in the elderly.Method One hundred and six elderly patients undergoing hip arthroplasty from February 2016 to March 2019 were randomly divided into two groups:group A and group B.Group A patients were injected 0.50%ropivacaine into the subarachnoid space.Group B patients were injected 0.25%ropivacaine into the subarachnoid space.The changes of mean arterial pressure(MAP),heart rate(HR),the degree of motor nerve block,sensory recovery time,motor recovery time and duration of anesthesia were compared between the two groups at different time points.The occurrence of adverse reactions occurred between and after the occurrence of adverse reactions.Result In group B,the proportions of patients with gradeⅠand gradeⅡmotor nerve block on the surgical side were 24.53%and 58.49%,respectively,which were higher than those of group A.The proportion of gradeⅢpatients was 16.98%,which was lower than that of group A.The diff erence was statistically signifi cant.(χ^2=7.3611,4.5725,17.8898,P<0.05);compared with group A,patients in group B have shorter sensory recovery time,exercise recovery time,and anesthesia duration,and the diff erence was statistically signifi cant(t=8.6326,10.2628,12.3698,P<0.05);the incidence of adverse reactions in group A was 22.64%,and group B was 7.55%,the diff erence was statistically signifi cant(χ^2=4.7111,P<0.05).Conclusion The anesthesia eff ect of 0.25%ropivacaine in subarachnoid space is better than that of 0.50%ropivacaine in elderly hip arthroplasty,and the safety of ropivacaine is higher than that of 0.50%ropivacaine in subarachnoid anesthesia.