不同浓度和容量的罗哌卡因在老年患者腰丛-坐骨神经联合阻滞中的应用

摘要

目的：观察两种不同浓度、不同容量的罗哌卡因用于腰丛-坐骨神经联合阻滞对老年患者下肢手术麻醉的效果和安全性。方法选择择期行单侧下肢手术的老年患者90例，将其随机分为3组各30例：0.3％罗哌卡因60 ml 组（A 组）、0.4％罗哌卡因45 ml 组（B 组）、0.4％罗哌卡因60 ml 组（C 组）。各组在神经刺激器引导下行单侧腰丛-坐骨神经联合阻滞，均按2∶1分配腰丛和坐骨神经的局部麻醉药容量，观察麻醉起效时间、持续时间、阻滞范围以及血流动力学变化和不良反应的发生情况。结果C 组的感觉和运动阻滞的起效时间快于 A、B 组（P ＜0.05），持续时间长于 A、B 组（P ＜0.05）。A 组和 C 组的阻滞范围明显大于 B 组（P ＜0.05），A、C 组之间无明显差别。A、C 组患者在神经阻滞下均能完成手术，B 组有5例患者由于镇痛不全或肌松效果较差，需辅助静脉麻醉或改为全身麻醉才能完成手术。结论低浓度高容量（0.3％、60 ml）的罗哌卡因用于腰丛-坐骨神经联合阻滞能为老年患者下肢手术提供较好的麻醉效果，同时可减少局部麻醉药用量并提高麻醉安全性。%Objective To evaluate the effect and safety of ropivacaine of different concentration and volume on lumbar plexus-sciatic nerve block in elderly patients undergoing lower limb surgery.Methods A total of 90 elderly patients scheduled for unilateral lower limb surgery were randomly divided into three groups (n =30 for each group).Guided by the nerve stimulator,lumbar plexus-sciatic nerve block was performed in group A with 60 ml of 0.3% ropivacaine,group B with 45 ml of 0.4% ropivacaine and group C with 60 ml of 0.4% ropivacaine,respectively.The ratio of topical volume of anesthetics between lumbar plexus and sciatic nerve was 2∶1.Onset time,duration and block extent were statistically compared among different groups.He-modynamic changes and the incidence of adverse events were recorded.Results The onset time of sensory and motor block in group C was significantly earlier than those in groups A and B (both P <0.05),and the dura-tion in group C was significantly longer than those in groups A and B (both P <0.05).The block extent in groups A and C was significantly larger than that in group B (both P <0.05),whereas no significant difference was observed between groups A and C.All patients in groups A and C successfully underwent the surgery under nerve block.However,five patients in group B required additional intravenous anesthesia or completed the sur-gery under general anesthesia due to low effect of nerve blocking.Conclusions Lumbar plexus-sciatic nerve block with low concentration and high volume of ropivacaine can provide satisfactory anesthetic effect,reduce the dosage of local anesthetics and thus improve anesthetic safety for elderly patients undergoing lower limb sur-gery.