不同剂量罗哌卡因在老年关节置换手术中行腰硬联合麻醉的效果分析及对术后认知功能的影响

Application of different doses of ropivacaine in CSEA of elderly patients undergoing joint replacement and the impact on postoperative cognitive function

目的:分析不同剂量罗哌卡因在老年髋关节置换手术中行腰硬联合麻醉(CSEA)的效果分析。方法:选择109例行髋关节置换术老年患者为研究对象,按腰麻不同用药量分为A组(n=36)、B组(n=36)和C组(n=37)。L3-4间隙穿刺后行蛛网膜下腔穿刺,A组、B组、C组蛛网膜下腔分别注入0.5%罗哌卡因10 mg、12 mg和15 mg,并于硬膜外导管注入1%罗哌卡因维持麻醉。比较麻醉效果、疼痛程度(VAS)评分、血流动力学[动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))]、认知功能(MMSE)及不良反应发生情况。结果:C组及B组感觉、运动阻滞起效时间均短于A组(P<0.05);各组感觉、运动阻滞恢复时间比较:C组>B组>A组(P<0.05);术后4、8 h,B组、C组VAS评分低于A组(P<0.05);各组T1、T2、T3时HR、MAP比较:C组<B组<A组(P<0.05);A组、B组手术结束和术后24 h MMSE评分均高于C组(P<0.05);A组、B组不良反应发生率均低于C组(P<0.05)。结论:12 mg剂量罗哌卡因在老年髋关节置换术CSEA中的效果理想,对血流动力学、认知功能影响小,安全性高。

Objective:To analyze the application of different doses of ropivacaine in combined spinal and epidural anesthesia(CSEA)of elderly patients undergoing hip replacement.Methods:109 elderly patients who underwent elective hip replacement were divided into group A(n=36),group B(n=36)and group C(n=37)according to the medication for anesthesia.Puncture in subarachnoid space was performed after puncture in the L3-4 gap.Group A,group B and group C were given subarachnoid injection of 10 mg,12 mg and 15 mg of ropivacaine(0.5%),respectively.Ropivacaine(1%)was injected into the epidural catheter to maintain anesthesia.The anesthetic effects,pain degree(VAS)score,hemodynamics[arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO_(2))],cognitive function(MMSE),and adverse reactions were compared between the groups.Results:The onset time of sensory and motor block in group B and group C was shorter than that in group A,and the recovery time was longer than that in group A(P<0.05).The recovery time of sensory and motor block in group B was shorter than that in group C(P<0.05).The VAS scores of group B and group C at 4 and 8 h after surgery were lower than those of group A(P<0.05).At T1,T2 and T3,HR and MAP of group C,group B,and group A increased in sequence(P<0.05).The MMSE scores of group A and group B at the end of surgery and 24 h after operation were higher than those of group C(P<0.05).The incidence rates of adverse reactions in group A and group B were lower than that in group C(P<0.05).Conclusion:12 mg of ropivacaine can achieve more ideal effect in CSEA for elderly patients undergoing hip replacement,with less influence on hemodynamics and cognitive function,and with high safety.