单侧脊麻-硬膜外联合麻醉在高龄患者髋部手术中的应用

摘要

目的 观察单侧脊麻-硬膜外联合麻醉用于高龄患者髋部手术的麻醉效果和安全性.方法 选择150例拟髋部手术高龄患者,年龄75～101岁,随机分成三组:持续硬膜外麻醉组(CEA组)、脊麻-硬膜外联合麻醉组(CSEA组)和单侧脊麻复合硬膜外麻醉组(OCSEA组),每组50例.选择第2～3腰椎或第3～4腰椎椎间隙为穿刺点,CEA组单纯硬膜外腔给药,阻滞药为1.5%利多卡因或1%利多卡因与0.375%布比卡因混合液,首剂总量7～12 ml;CSEA组蛛网膜下腔给药后头向置入硬膜外导管3.5 cm备用后立即平卧,OCSEA组蛛网膜下腔给药及头向置入硬膜外导管后仍保持侧卧位10～15 min.麻醉平面尽可能控制在第10胸椎以下.CSEA组和OCSEA组脊麻用药均为0.5%布比卡因重比重液1.5～1.7 ml.比较三组的麻醉平面、麻醉效果及血压变化情况.结果 CSEA组和OCSEA组麻醉效果优于CEA组,CSEA组和OCSEA组的麻醉平面比CEA组更容易控制,OCSEA组的血压更为稳定,差异有统计学意义(P＜0.05).结论 0.5%布比卡因重比重液小剂量单侧脊麻复合硬膜外麻醉血压变化小,安全有效,较适合高龄患者髋部手术的麻醉.%Objective To observe the effect and safety of unilateral spinal anesthesia-epidural anesthesia for elderly patients with hip surgery. Methods A total of 150 elderly patients scheduled for hip surgery, aged 75 to 101 years old, were randomly divided into three groups :continuous epidural anesthesia group (CEA group), spinal-epidural anesthesia group (CSEA group) and unilateral spinal anesthesia combined with epidural anesthesia group (OCSEA group), 50 cases in each group. Choosing L2-3 or L3-4 intervertebral space as the puncture site, CEA group were epidural administration, blockers of 1.5% lidocaine or 1% lidocaine with 0. 375% bupivacaine, the first agent volume 7-12 ml; CSEA group during the first administration to the subarachnoid epidural catheter was placed supine immediately after the backup 3.5 cm. OCSEA group subarachnoid administration and the first epidural catheter to maintain the lateral position after 10-15 min. Control of anesthesia as the following in T10. CSEA group and OCSEA spinal drug group were 0. 5% hyperbaric bupivacaine solution 1.5-1.7 ml. Comparing three groups of anesthesia, anesthesia and blood pressure changes. Results CSEA group and OCSEA anesthesia were better than the CEA group. The anesthetic plane of CSEA group and OCSEA group were easier to control than that of the CEA group. OCSEA group has more stable blood pressure(P＜0.05).Conclusions 0.5% solution of low dose hyperbaric bupivacaine spinal anesthesia combined with epidural anesthesia unilateral was vary in blood pressure. It is safe and effective, and more suitable for elderly patients with hip surgery anesthesia.