老年患者单侧髋关节置换术应用轻比重布比卡因腰硬联合阻滞麻醉效果的临床研究

摘要

Objective The aim of the present study was to investigate the safety and efficacy of hypobaric bupivacaine used in combined spinal and epidural anesthesia(CSEA)for the elderly people with unilateral hip replacement. Methods 59 elderly patients with unilateral hip replacement were randomly divided into two groups:group A with 0. 375% bupivacaine 2. 5 ml(2 ml 0. 75% bupivacaine and 2 ml sterile distilled water diluted to 4ml,then 2. 5 ml out);group B with 0. 375% bupivacaine 2. 5 ml(2 ml 0. 75% bupivacaine and 2 ml sterile 10% glucose dilu-ted to 4ml,then 2. 5 ml out). Adverse reactions including hypotension,bradycardia,shivering,nausea,vomiting which happened intraoperative-ly,and postoperative headaches,nervous system complications and their incidence,the times of using ephedrine and atropine intraoperatively were observed. Results The unilateral block incidence was higher in group A than that in group B at the 15 th minute( P ﹤ 0. 05). The motor block-ade score was higher in group B than that in group A at the 150 th minutes( P ﹤ 0. 05). Blood pressure fluctuations in group B was higher than that in group A( P ﹤ 0. 05). The times of using ephedrine intraoperatively was more in group B than in group A( P ﹤ 0. 05). Compared with group B,the intraoperative incidence of hypotension,shivering,nausea,vomiting was lower in group A( P ﹤ 0. 05). Conclusion Unilateral hip replacement surgery in the elderly under combined spinal - epidural anesthesia with hypobaric bupivacaine can reduce intraoperative hemodynamic fluctuations,and unilateral lumbar hemp block rate is high,fast recovery of motor function,fewer complications,and it is safe and reliable.%目的：探讨老年患者单侧髋关节置换术应用轻比重布比卡因腰硬联合阻滞的麻醉效果。方法选取骨科行单侧髋关节置换的老年患者59例随机分为轻比重布比卡因组（实验组）和重比重布比卡因组（对照组）。观察两组患者的麻醉阻滞效果、改良 Bromage 评分、同时记录麻醉前（T0）、麻醉后1min、5 min、10 min、15 min、30 min、60 min 和90 min（T1- T7）8个时间点的心率（HR）、平均动脉压（MAP）与动脉血氧饱和度（SpO2）的水平，对患者术中和术后的并发症也进行比较。结果与重比重布比卡因（对照组）组相比，使用轻比重布比卡因（实验组）的最高阻滞平面较高（ P ﹤0.05），T10阻滞时间长（ P ﹤0.05），单侧的神经阻滞的比率高（ P =0.023），改良 Bromage 评分明显降低（ P ﹤0.01）。实验组患者 T5和 T6两个时间点的 HR 明显低于对照组（ P =0.03），T1- T5的5个时间实验组的 SpO2明显高于对照组（ P ﹤0.01）。实验组术中因低血压使用麻黄碱的例数明显低于对照组（ P =0.003）；实验组患者出现低血压、恶心、呕吐和寒颤的几率也明显低于对照组（ P ﹤0.05）。结论老年人单侧髋关节置换手术时使用轻比重布比卡因腰硬联合阻滞能够减少术中血流动力学波动，且单侧阻滞率高、术后运动功能恢复快、并发症少，安全可靠。