不同比重麻醉药椎管内麻醉用于老年患者髋关节置换手术中的效果比较

Comparison of effects of spinal anesthesia with different specific gravity anesthetics for elderly patients undergoing hip replacement

目的探讨不同比重麻醉药椎管内麻醉用于老年患者髋关节置换手术中的效果。方法选择行髋关节置换术的老年患者60例为研究对象,随机分为A、B与C,每组20例。A组5 g/L布比卡因1 ml+脑脊液1 ml(等比重),B组5 g/L布比卡因1 ml+注射用水1 ml(轻比重),C组5 g/L布比卡因1 ml+10%葡萄糖1 ml(重比重)进行麻醉,观察3组患者感觉阻滞起效时间、阻滞平面固定时间、感觉阻滞持续时间,运动阻滞起效时间、最大运动阻滞时间、最大Bomage评分。记录3组麻醉前、麻醉后10、30 min以及手术结束后心率、收缩压、舒张压水平。结果 C组感觉阻滞起效时间最短,平面固定时间最短,感觉阻滞持续时间最长,运动阻滞起效时间最短,最大运动阻滞时间最短,最大Bromage评分最高(P<0.05)。B组在麻醉前及麻醉后不同时间点心率、血压变化差异无统计学意义(P>0.05);A组在麻醉后30 min HR显著高于麻醉前,收缩压、舒张压显著低于麻醉前,差异均有统计学意义(P<0.05);C组在麻醉后10 min及30 min HR显著高于麻醉前,收缩压、舒张压显著低于麻醉前,差异均有统计学意义(P<0.05)。结论重比重利比卡因用于老年患者髋关节置换术的椎管内麻醉起效最快,但对运动功能以及心率、血压影响较大;轻比重相麻醉起效快,并且对心率、血压影响小;等比重双侧肢体麻醉,起效慢,麻醉效果差。

Objective To observe the effects of spinal anesthesia with different specific gravity anesthetics for elderly patients undergoing hip replacement.Methods A total of 60 elderly patients who underwent hip replacement in our hospital from January 2016 to June 2018 were enrolled in the study,who were randomly divided into group A,group B and group C,with 20 cases in each group.The patients group A received spinal anesthesia with 5 g/L bupivacaine 1 ml+cerebrospinal fluid 1 ml(isobaric proportion),the patients in group B were treated by 5 g/L bupivacaine 1 ml+water for injection 1 ml(light specific gravity),and the patients in group C were treated with 5 g/L bupivacaine 1 ml+10%glucose injection 1 ml(heavy specific gravity).The onset time of sensory block,the fixed time of block plane,the duration of sensory block,onset time of motor block,maximum time of motor block and the maximum Bomage score were observed and compared among the three groups.Moreover the heart rate,systolic blood pressure and diastolic blood pressure were recorded before anesthesia,at 10 minutes and 30 minutes after anesthesia and after operation.Results The onset time of sensory block was the shortest in group C,with the shortest planar fixation time,the longest duration of sensory block,the shortest onset time of motor block,the shortest maximum duration of motor block and the highest Bromage score(P<0.05).There were no significant differences in the rate of pastry and blood pressure in group B before and after anesthesia(P>0.05).The HR at 30 minutes after anesthesia in group A was significantly higher than that before anesthesia,however,the systolic blood pressure and diastolic blood pressure were significantly lower than tose before anesthesia(P<0.05).Moreover the HR at 10 min and 30 min after anesthesia in group C was significantly higher than that before anesthesia,however,the systolic pressure and diastolic pressure were significantly lower than those before anesthesia(P<0.05).Conclusion Intraspinal anesthesia with weight specific gravity for hip replacement in elderly patients has the advantage of fastest onset,but which has obvious effects on motor function,heart rate and blood pressure.Light specific gravity anesthesia is effective and has little effect on heart rate and blood pressure.Isobaric proportion anesthesia has slower onset and poor anesthetic effects.