不同剂量轻比重布比卡因腰椎麻醉在老年单侧下肢手术中应用效果

Application effects of lumbar anesthesia with different doses of hypobaric bupivacaine in elderly patients undergoing unilateral lower limb surgery

目的:比较不同剂量轻比重布比卡因腰椎麻醉在老年单侧下肢术中应用效果。方法:选取我院88例老年单侧下肢手术患者,随机分为三组,A组轻比重布比卡因0.033 mg·cm^(-1),B组0.05 mg·cm^(-1),C组0.08 mg·cm^(-1),比较手术指标,于术前(T1)、麻醉用药5 min(T2)、15 min(T3),采用监护仪监测血流动力学指标,包括心率(Heart rate,HR)、平均动脉压(Mean arterial pressure,MAP),同时评估麻醉平面固定时间、阻滞效果、术中低血压。结果:A组、B组血管活性药物应用率低于C组(P<0.05);C组HR、MAP波动最大,A组最小(P<0.05);麻醉平面固定时间、麻醉起效时间:A组>B组>C组(P<0.05);A组、B组阻滞持续时间短于C组(P<0.05),改良Bromage评分、术中低血压发生率低于C组(P<0.05)。结论:0.033mg/cm轻比重布比卡因腰椎麻醉对血流动力学的影响较小,0.08 mg/cm大剂量麻醉起效更快,阻滞持续更久。

Objective:To compare the application effects of lumbar anesthesia with different doses of hypobaric bupivacaine in elderly patients undergoing unilateral lower limb surgery.Methods:A total of 88 elderly patients who underwent unilateral lower limb surgery in the hospital were selected,and randomLy divided into three groups.Groups A,B,and C were given lumbar anesthesia with 0.033,0.05,and 0.08 mg·cm^(-1) of hypobaric bupivacaine,respectively.Surgical indicators in the three groups were compared.The hemodynamic indicators,including heart rate(HR)and mean arterial pressure(MAP),were monitored using a monitor before surgery(T1),at 5 minutes after administration for anesthesia(T2),and 15 minutes after administration for anesthesia(T3).The anesthesia plane fixation time,block effects,and intraoperative hypotension were evaluated.Results:The utility ratios of vasoactive drugs in groups A and B were lower than those in group C(P<0.05).The fluctuations of HR and MAP in group C were the greatest,and those in group A were the smallest(P<0.05).The anesthesia plane fixation time and onset time of anesthesia decreased in sequence from group A,and group B to group C(P<0.05).The duration of the block in Group A and Group B was shorter than that in Group C(P<0.05).The modified Bromage scores and the incidence rates of intraoperative hypotension were lower than those in group C(P<0.05).Conclusion:Lumbar anesthesia with 0.033 mg/cm of hypobaric bupivacaine has less influence on hemodynamics,while high-dose anesthesia with 0.08 mg/cm of hypobaric bupivacaine takes effect faster and the duration of anesthesia is longer.