不同比重同剂量罗哌卡因蛛网膜下腔阻滞在老年下肢骨折手术中的应用效果

Application effect of different specific gravity and same dose of ropivacaine for subarachnoid block in elderly lower limb fracture surgery

目的观察不同比重同剂量罗哌卡因蛛网膜下腔阻滞在老年下肢骨折手术中的应用效果。方法将80例老年下肢骨折患者根据罗哌卡因比重不同分为E组与W组,各40例。E组采用等比重罗哌卡因蛛网膜下腔阻滞,W组采用重比重罗哌卡因蛛网膜下腔阻滞。比较两组的应用效果。结果T1~T4时,E组的MAP、HR、SV变化幅度小于W组(P<0.05)。麻醉后30 min,E组的PRA、AngⅡ、醛固酮水平优于W组(P<0.05)。E组的术后排尿恢复时间、下肢运动恢复时间短于W组(P<0.05);术后24 h,E组的CAM评分显著低于W组(P<0.05)。结论等比重罗哌卡因蛛网膜下腔阻滞应用于老年下肢骨折手术中,不仅可获得较好的麻醉效果,还能减少血流动力学、RAAS系统的波动,促进术后恢复。

Objective To observe the application effect of different specific gravity and same dose of ropivacaine for subarachnoid block in elderly lower limb fracture surgery.Methods A total of 80 elderly patients with lower limb fractures were divided into group E and group W by the different specific gravity of ropivacaine,with 40 cases in each group.The group E was treated with equal specific gravity ropivacaine for subarachnoid block,and the group W was treated with heavy specific gravity ropivacaine for subarachnoid block.The application effects of the two groups were compared.Results From T1 to T4,the range of change of MAP,HR and SV in the group E were less than those in the group W(P<0.05).At 30 min after anesthesia,the levels of PRA,AngⅡand aldosterone in the group E were better than those in the group W(P<0.05).The recovery time of postoperative micturition and lower limb movement in the group E were shorter than those in the group W(P<0.05);at 24 h after operation,the CAM score in the group E was significantly lower than that in the group W(P<0.05).Conclusion Equal specific gravity ropivacaine for subarachnoid block applied in elderly lower limb fracture surgery can not only obtain good anesthetic effect,but also reduce the fluctuation of hemodynamics and RAAS system and promote the postoperative recovery.