罗比卡因等比重液用于老年病人腰-硬联合阻滞的临床研究  

Clinical study on combined spinal-epidural anesthesia with isobaric ropivacaine used in aged patients

作　　者：郑颖梅[1] 沈跃华[1] 程建新[1] 徐建国[2] 

机构地区：[1]南京医科大学附属常州第二人民医院麻醉科,常州市213003 [2]南京军区南京总医院麻醉科

出　　处：《临床麻醉学杂志》2005年第3期174-176,共3页Journal of Clinical Anesthesiology

摘　　要：目的　研究罗比卡因等比重液用于老年病人腰 硬联合阻滞的安全性和有效性。方法 择期行下肢手术老年病人90例,ASAI～Ⅱ级,随机分成三组,每组30例。用DurasafeTM型联合阻 滞配套针于L3～4间隙穿刺。以0.1ml/s的速率蛛网膜下隙注入等比重混和局麻药3ml(B组:布比 卡因7.5mg;R1组:罗比卡因7.5mg;R2组:罗比卡因10mg),术中酌情于硬膜外给予2%利多卡因 维持麻醉。用针刺法测感觉阻滞平面,用改良Bromage法测运动阻滞程度。比较三组病人在感觉、 运动阻滞及恢复上的异同,记录麻醉各时点血压、心率变化,并观察用药后的不良反应。结果　三组 均能提供较为完善的麻醉。R组的运动阻滞起效时间长于B组(P<0.01),运动阻滞恢复时间短于 B组(P<0.01)。R1组感觉阻滞消退到S1～2时间、完全运动阻滞发生率、尿潴留发生率明显少于B 组(P<0.01)。结论　罗比卡因等比重液7.5mg腰 硬联合阻滞用于老年病人是安全的,其循环和 呼吸系统较稳定,未见严重并发症,并能达到较为完善的麻醉效果。Objective To determine the clinical efficacy and safety of ropivacaine for combined spinal-epidural anesthesia(CSEA) in the aged patients. Methods Ninety aged patients,ASA Ⅰ-Ⅱ,undergoing elective lower limb surgery,were randomly allocated to receiving spinally isobaric mix-solusion of 0.25% bupivacaine 7.5 mg(group B,n=30),0.25% ropivacaine 7.5 mg(group R 1,n=30),or 0.33% ropivacaine 10 mg(group R 2,n=30) respectively,and the epidural anesthesia was maintained with 2% lidocaine if necessary during the operation. The level and duration of sensory anesthesia were recorded bilaterally by a pinprick test,and motor block in limb was assessed with a modified Bromage scale.Hemodynamic changes and side effects were observed after spinal anesthesia. Results Each group produced perfect quality of anesthesia.Compared with group B,group R produced longer time to maximum motor block and shorter time to motor recession(P<0.01).In adittion,in group R 1 shorter time to sensory block to S 1~2 and more incomplete moror lockage were observed(P<0.01). Conclusion Ropivacaine,spinally isobaric solusion 7.5 mg, is safe and effective for CSEA with a slable,circulation system and respiratory function in the aged patients.

关 键 词：罗比卡因 老年病人 腰-硬联合阻滞 临床研究 

分 类 号：R614[医药卫生—麻醉学]