三种椎管内麻醉在70岁以上患者人工关节置换术中应用的比较  

Clinical effects comparison of continuous spinal, epidural and combined spinal-epidural anesthesia for arthroplasty in the elderly over 70 years.

作　　者：阮祥才[1] 佘守章[1] 许立新[1] 董源洪[1] 

机构地区：[1]广州市第一人民医院麻醉科,510180

出　　处：《中华老年医学杂志》2005年第10期749-752,共4页Chinese Journal of Geriatrics

摘　　要：目的比较连续脊麻、腰硬联合麻醉和连续硬膜外腔阻滞在70岁以上患者人工关节置换术中的临床效应。方法60例71～98岁择期人工关节置换术患者〔美国麻醉医师协会(ASA)体格情况评级Ⅱ～Ⅲ级〕分为连续脊麻组、腰硬联合麻醉组和硬膜外腔阻滞组,每组20例。采取0.5%布比卡因分次小量给药的方法使麻醉无痛平面达胸椎10(T10)。结果各组麻醉效果良好;连续脊麻组运动阻滞评级高于硬膜外腔阻滞组;布比卡因用量以连续脊麻组〔(8.0±1.8)mg〕最小,腰硬联合麻醉组的〔(13.7±9.7)mg〕稍大,硬膜外腔阻滞组〔(39.4±16.6)mg〕最大,差异均有统计学意义(P<0.01或P<0.05)。平均动脉压最大抑制程度,连续脊麻组(-7%)明显低于腰硬联合麻醉组(-23%)或硬膜外腔阻滞组(-22%);腰硬联合麻醉组的心脏指数最大下降幅度(-22%)大于连续脊麻组(-5%);使用麻黄素患者比例连续脊麻组(5%)低于硬膜外腔阻滞组(20%)或腰硬联合麻醉组(25%),差异均有统计学意义(P<0.01或P<0.05)。组间术中估计出血量、输血量和补液速度比较,差异均无统计学意义(P>0.05)。结论采取分次小量给药的方法,连续脊麻、腰硬联合麻醉和连续硬膜外腔阻滞均可应用于70岁以上患者人工关节置换术,其中以连续脊麻血液动力学影响最为轻微。Objective To compare clinical effects of continuous spinal, epidural and combined spinal-epidural anesthesia for arthroplasty in the elderly over 70 years. Methods Sixty geriatric patients, ASA status Ⅱ-Ⅲ degree, aged 71 - 98 yr, undergoing arthroplasty operation on hip or knee joint, were randomly assigned to group of continuous spinal anesthesia, group of combined spinal epidural anesthesia, or group of continuous epidural anesthesia, with twenty patients of per group. T10 anesthesia level was aimed by 0.5% bupivacaine titrated carefully. Results All anesthesia were clinically satisfied with average anesthesia level T10 （T7-11）. Bromage＇s motor blockade scale in group of continuous spinal anesthesia was higher than that in group of continuous epidural anesthesia. Amount of bupivacaine consumptions were （8.0±1.8）mg, （13.7±9.7）mg, （39.4± 16.6） mg in groups of continuous spinal anesthesia, combined spinal-epidural anesthesia, and continuous epiduralanesthesia respectively （P〈0.01-0.05）. Maximum decrease of mean arterial pressure in group of continuous spinal anesthesia（- 7%was lower than that in group of continuous epidural anesthesia （- 23 % ） or group of continuous epidural anesthesia（- 220%）. Maximum decrease of cardiac index in group of continuous spinal anesthesia （- 5%） was lower than that in group of continuous epidural anesthesia（- 22% ）. Cases of needing ephedrine treatment in group of continuous spinal anesthesia （5%） were fewer than that in group of combined spinal epidural anesthesia （25%） and group of continuous epidural anesthesia （20%） （P〈0.01-0.05）. There were no significant differences among the groups in blood losing, intravenous fluid infusion or blood infusion（P〉0.05）. Conclusions With 0.5% bupivacaine titrated carefully, all kinds of continuous spinal, epidural and combined spinal epidural anesthesia are clinical efficient in the elderly over 70 years for arthroplasty, of which continuous spinal anesthesia is recommended

关 键 词：麻醉 脊椎 布比卡因 关节成形术 

分 类 号：R614[医药卫生—麻醉学]