0．75％罗哌卡因与0．75％布比卡因用于高龄下肢手术患者连续腰麻对比研究

摘要

目的：研究小剂量0．75％罗哌卡因在高龄下肢手术患者中的应用，并与0．75％布比卡因作对比研究。方法择期高龄下肢手术患者40例，年龄70～93岁，ASAⅠ～Ⅲ级，随机分为罗哌卡因组和布比卡因组，每组20例。2组分别在蛛网膜下腔分次小剂量注入0．75％罗哌卡因10 mg或0．75％布比卡因10 mg，直至出现最高有效麻醉平面，比较2组患者痛觉阻滞程度、最高阻滞平面、运动阻滞程度（改良Bromage分级法，MBS），且记录麻醉前（T0）、麻醉平面达到有效麻醉平面时（T1）、切皮后2 h（T2）和术毕（T3）心率、平均动脉压的变化。结果2组患者均可达到完善的镇痛效果，但罗哌卡因组的镇痛起效时间、运动阻滞起效时间、最大运动阻滞时间均比布比卡因组显著延长（P＜0．05）；最高阻滞平面低于布比卡因组（P＜0．05）；而痛觉恢复时间、运动恢复时间较布比卡因组显著缩短（P＜0．05）；罗哌卡因组最大Bromage分级明显优于布比卡因组（P＜0．05）。结论小剂量0．75％罗哌卡因在连续腰麻中应用于高龄患者下肢手术，麻醉效果满意，而且能够达到较为完善的镇痛效果，肌肉松弛好，为高龄患者的手术麻醉提供了一种有效且安全可行的方法。%Objective To investigate the clinical effects of 0.75%ropivacaine and 0.75%bupivacaine in continu-ous spinal anesthesia ( CSA) for lower limbs operation in elderly patients .Methods 40 cases of elderly patients ( aged 70-93 years, ASAⅠ-Ⅲ) were randomly devided into ropivacaine group (group R, n=20) and bupivacaine group (group B, n=20).The patients were injected with fractionated low dose of 10 mg 0.75%ropivacaine (group R) or 10 mg 0.75%bupivacaine ( group B) into the subarachnoid space at L 2-3 until the highest block level of effective anesthesia was reached .The degree of analgesia , highest pain blocking plane , and degrees of motor block ( modified Bromage scale , MBS) between the two groups were compared .The heart rate ( HR) and mean aterial pressure ( MAP) before anesthesia ( T0 ) , at the time when effective analgesic plane was reached ( T1 ) , 2 h after incision ( T2 ) , and at the end of operation (T3) were recorded.Results Satisfactory analgesic effect was observed in all the patients in the two groups .However, the time to onset of analgesia and motor block and the maximum motor block time in group R were considerably prolonged compared with group B (P<0.05).Compared with group B, group R had a lower highest pain blocking plane (P<0.05)and significanly shorter pain recovery time and motor recovery time (P<0.05).The time of pain and movement recovery was shorter in group R than in group B (P<0.05).The maximum MBS was much higher in group R compared with group B (P<0.05).Conclusions 0.75%low dose ropivacaine is safe and effective in CSA for lower limbs opera-tion in elderly patients , with better analgesic effect and muscle relaxation and less side effects and complications .It pro-vides an effective and safe way of anesthesia in operation for elderly patients .