两种重比重液蛛网膜下腔阻滞对老年患者下肢手术麻醉效果及术中血流动力学的影响

摘要

[目的]探讨两种重比重液蛛网膜下腔阻滞对老年患者下肢手术麻醉效果及术中血流动力学的影响.[方法]择期老年患者拟行下肢手术病人102例,年龄65～75岁,ASAⅡ～Ⅲ级,随机分为A组(5%葡萄糖稀释的布比卡因,比重1.0107),B组(10%葡萄糖稀释的布比卡因组,比重1.060),每组51例.用腰麻硬膜外联合麻醉(CSEA)技术的针内针法经 L2~3实施腰麻,均采用0.5%布比卡因2.0 mL,测定和评价术中麻醉质量和肌松效果,比较两组患者术中血流动力学的变化、麻醉起效时间、感觉阻滞的峰平面、达最高感觉阻滞平面的时间、运动阻滞Bromage评分达3级的时间,阻滞后低血压、心动过缓、呼吸抑制(SpO2<90%)的情况,使用麻黄碱和阿托品的总量和例数.[结果]两组注药后麻醉起效时间、麻醉质量和肌松效果差异无统计学意义(P>0.05).运动阻滞达改良Bromage评分3级的时间、感觉阻滞达峰平面的时间A组迟于B组,感觉阻滞的最多节段数(Dmax)A组少于B组,差异有统计学意义(P<0.05).两组间低血压和心动过缓等不良反应发生率和使用麻黄素、阿托品总量和例数,A组显著少于B组(P<0.05); A组给药后平均动脉压最低值的出现时间、下降幅度与B组比较有统计学差异(P<0.05),A组变化趋于平缓.[结论]比重为1.0107腰麻液蛛网膜下腔阻滞对老年患者下肢手术的血流动力学影响小,安全可靠.%[Objective]To explore the effect of two hyperbaric solutions for subarachnoid block on anesthesia efficacy and intraoperative hemodynamics in elderly patients undergoing lower limb operation. [Methods] Totally 102 ASA II ~ HI elderly patients (aged 65~75 years old) scheduled for lower limb operation were randomly divided into group A(5% bupivacaine diluted by glucose solution with 1. 0107 of specific gravity) and group B(10% bupivacaine diluted by glucose solution with 1. 060 of specific gravity) with 15 patients in each group. Spinal needle in epidural needle method in combined spinal epidural anesthesia(CSEA) was used for spinal anesthesia with 2. 0ml bupivacaine 0. 5% via L2~3. The quality of anesthesia and the effect of muscle relaxation were measured and evaluated during the operation. Hemodynamic change, onset time of anesthesia, the time to reach peak sensation block, the time of motor block Bromage scale reaching grade 3 , the incidence of hypotension, bradycardia and respiratory depression(SpO2<90%) and the dose and case number using ephedrine and atropine were compared between two groups during the operation. [Results]There was no significant difference in onset time of anesthesia, the quality of anesthesia and muscle relaxation between two groups after injection( P >0. 05). The time of motor block Bromage scale reaching grade 3 and the time to reach peak sensation block in group A were slower than those in group B, and the maximum segment of sensation block(Dmax) in group A was less than that in group B, and there were significant differences( P <0. 05). The incidence of adverse reactions such as hypotension and bradycardia and the dose and case number of ephedrine and atropine in group A were markedly less than those in group B ( P <0. 05). There was significant difference in the emergence time of mean arterial pressure(MAP) after injection between group A and group B( P <0. 05) , and the change in group A was mild. [Conclusion]Spinal anesthesia solution with 1. 0107 of specific gravity for subarachnoid block has less impact on hemodynamics of elderly patients undergoing lower limb operation, and is safe and reliable.