罗哌卡因腰椎硬膜外联合麻醉与连续硬膜外麻醉在高龄患者人工全膝关节置换术中的应用效果比较

Comparison of application effects of Ropivacaine combined lumbar epidural anesthesia and continuous epidural anesthesia in elderly patients undergoing total knee arthroplasty

目的:比较罗哌卡因腰椎硬膜外联合麻醉与连续硬膜外麻醉(CEA)在高龄患者人工全膝关节置换术(TKA)中的应用效果。方法:选取2019年6月至2021年6月于该院行TKA治疗的100例高龄患者进行前瞻性研究,按照随机数字表法分为观察组与对照组各50例。对照组采用CEA麻醉,观察组采用罗哌卡因腰椎硬膜外联合麻醉,比较两组麻醉优良率、血流动力学指标[心率和平均动脉压(MAP)]水平、麻醉起效时间、阻滞完善时间和不良反应发生率。结果:观察组麻醉优良率为96.00%,明显高于对照组的82.00%,差异有统计学意义(P<0.05)。麻醉后30 min,观察组心率水平低于对照组;麻醉后30 min、术毕,观察组MAP水平高于对照组,差异有统计学意义(P<0.05)。观察组麻醉起效时间、阻滞完善时间均短于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率为6.00%,低于对照组的20.00%,差异有统计学意义(P<0.05)。结论:罗哌卡因腰椎硬膜外联合麻醉应用于高龄患者TKA术中可提高麻醉优良率,缩短麻醉起效时间和阻滞完善时间,改善血流动力学指标水平,以及降低不良反应发生率,优于CEA麻醉效果。

Objective:To compare application effects of Ropivacaine combined lumbar epidural anesthesia and continuous epidural anesthesia(CEA)in elderly patients undergoing total knee arthroplasty(TKA).Methods:100 elderly patients who received TKA treatment in this hospital from June 2019 to June 2021 were selected for the prospective study,and were divided into observation group and control group according to the random number table method,50 cases in each.The control group was given CEA anesthesia,while the observation group was given Ropivacaine combined lumbar epidural anesthesia.The excellent and good rate of anesthesia,the hemodynamic index levels[heart rate(HR)and mean arterial pressure(MAP)],the anesthesia onset time,the block completion time,and the incidence of adverse reactions were compared between the two groups.Results:The excellent and good rate of anesthesia in the observation group was 96.00%,which was significantly higher than 82.00%in the control group,and the difference was statistically significant(P<0.05).30 minutes after anesthesia,the HR level in the observation group was lower than that in the control group;30 minutes after anesthesia and after the surgery,the MAP levels in the observation group were higher than those in the control group;and the differences were statistically significant(P<0.05).The anesthesia onset time and the block completion time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).Further,the incidence of adverse reactions in the observation group was 6.00%,which was lower than 20.00%in the control group,and the difference was statistically significant(P<0.05).Conclusions:Ropivacaine combined with lumbar epidural anesthesia in the elderly patients undergoing TKA can improve the excellent and good rate of anesthesia,shorten the anesthesia onset time and the block completion time,improve the level of hemodynamic indexes,and reduce the incidence of adverse reactions.Moreover,it is superior to the CEA anesthesia.