不同穿刺间隙对高龄患者轻比重布比卡因单侧蛛网膜下隙阻滞特征的影响

摘要

Objective To explore the effects of different spinal interspaces on the characteristics of unilateral subarachnoid block (unilateral spinal anesthesia) with administration of hypobaric bupivacaine for the elderly patients.Methods According to different spinal interspaces, 90 elderly patients were randomly equally divided into groups Ⅰ,Ⅱ and Ⅲ (group Ⅰ at L3~4, group Ⅱ at L4~5 and group Ⅲ at L5~S1).All the patients received equal 7.5 mg of 0.3% hypobaric bupivacaine for unilateral spinal block.The onset time and the lasting time for sensory and motor block, maximum sensory block level, and the success rate of unilateral spinal anesthesia, the failure rate of anesthesia, blood pressure and retention of urine were observed.Results ①Compared the onset time for sensory and motor block among the three groups showed that group Ⅰhad the fastest onset time, followed by group Ⅱ, and then group Ⅲ (P<0.05).②Compared the lasting time for sensory and motor block among the three groups showed that there were no statistical differences (P>0.05).③Compared the maximum sensory block level among the three groups showed that Group Ⅰ was higher than Group Ⅲ (P<0.05).④Compared the success rate of unilateral spinal anesthesia, the failure rate of anesthesia and the rate of postoperative urinary retention among the three groups showed that there were no statistical differences (P>0.05).⑤After patients changed to dorsal position, the mean blood pressure in all patients did not decrease (P>0.05).Conclusion During unilateral spinal anesthesia with hypobaric bupivacaine for the elderly patients, the higher the position of spinal interspace was, the faster the onset time for sensory and motor block was and the higher the sensory block level was, but the lasting time of block for sensory and motor block, the success rate of unilateral spinal anesthesia, the failure rate of anesthesia and the rate of postoperative urinary retention were not related to the biopsy interspaces.%目的 探讨不同的穿刺间隙对高龄患者轻比重布比卡因单侧蛛网膜下隙阻滞(单侧腰麻)特征的影响.方法 将90例高龄患者根据不同的穿刺间隙随机等分成3组:Ⅰ组为L3~4间隙、Ⅱ组为L4~5间隙、Ⅲ组为L5~S1间隙.均用0.3%轻比重布比卡因7.5 mg进行单侧腰麻,观察3组感觉和运动阻滞起效和持效时间、最高感觉阻滞平面、单侧腰麻的比率、麻醉失败率、血压及尿潴留等情况.结果 ①3组感觉和运动阻滞起效时间比较,Ⅰ组<Ⅱ组<Ⅲ组(P<0.05).②3组感觉和运动阻滞持效时间比较,差异均无统计学意义(P>0.05).③3组最高感觉阻滞平面比较,Ⅰ组高于Ⅲ组(P<0.05).④3组单侧腰麻的比率、麻醉的失败率及术后尿潴留率等比较,差异均无统计学意义(P>0.05).⑤变仰卧位后均未出现平均动脉压下降的情况(P>0.05).结论 高龄患者行轻比重布比卡因单侧腰麻,穿刺间隙位置越高,则阻滞起效越快,最高感觉阻滞平面越高,但持效时间、单侧腰麻的比率、麻醉的失败率及术后尿潴留等均与穿刺间隙无关.