小剂量轻比重罗哌卡因腰硬联合麻醉用于老年人髋关节手术的观察

摘要

目的 总结小剂量轻比重罗哌卡因腰硬联合麻醉用于老年人髋关节手术,并与连续硬膜外麻醉相比较,观察麻醉效果、生命指征变化及并发症发生率.方法 选择行全髋或半髋关节置换术患者50例分为观察组和对照组,每组25例.观察组采用小剂量轻比重罗哌卡因腰硬联合麻醉,对照组采用常规连续硬膜外麻醉.记录2组患者患侧感觉和运动阻滞起效时间,健侧Bromage评分、辅助用药、生命指征变化及不良反应发生率.结果 观察组感觉阻滞和运动阻滞起效时间明显短于对照组(P＜0.05),观察组健侧肢体的运动阻滞较对照组显著减轻(P＜0.05),对照组辅助用药病例较观察组明显增多(P＜0.05).2组患者麻醉前基础收缩压和舒张压比较差别均无统计学意义(P＞0.05).观察组麻醉后各时间点的收缩压及舒张压与麻醉前基础血压比较,差别无统计学意义(P＞0.05).对照组收缩压在麻醉后10、15、20min时与基础压比较差别有统计学意义(P＜0.05).结论 小剂量轻比重罗哌卡因腰硬联合麻醉用于老年人髋关节手术血压更平稳,麻醉效果更满意.%Objective To summarize the application of combined spinal-epidural anesthesia with light specific gravity of low dose ropivacaine in the aged patients undergoing hip joint surgery and compare with continuous epidural anesthesia,then the anesthesia effects,the changes of vital signs and the incidence rate of complication were observed. Methods Fifty aged patients undergoing scheduled hemiarthroplasty or total hip arthroplasty were included and randomly divided into observation group and control group,twenty-five in each group. Observation group were given low dose ropivacaine(light specific gravity) by combined spinal-epidural anesthesia. Control group were given ropivacaine by general continuous epidural anesthesia. The patients' onset time of both feeling and motor block of affected side,unaffected Bromage grade,accessorial medication,changes of vital signs and the incidence rate of adverse reaction were recorded. Results Compared with control group, the onset time ofboth feeling and motor block of observation group was obviously shortened (P < 0.05). The unaffected side Bromage grade of observation group was distinctly lightened compared with that of control group (P < 0. 05 ). The systolic and diastolic blood pressure before anesthesia was no significant difference between observation group and control group (P > 0.05). There was no statistic difference of blood pressure before and after anesthesia in observation group(P > 0.05 ). The systolic blood pressure at 10,15,20 minutes after anesthesia in the control group was significantly different compared with the pressure before anesthesia ( P < 0.05). Conclusion The application of combined spinal-epidural anesthesia with light specific gravity of low dose ropivacaine in the aged patients undergoing hip joint surgery can lead to a more stabilized blood pressure and more satisfactory anesthesia effect.