轻比重罗哌卡因与左旋布比卡因用于高龄患者连续脊麻的可行性研究  

Feasibility study of continuous spinal anesthesia for lower limb joint replacement in elderly patients with hypobaric ropivacaine and evobupivacaine

作　　者：刘继云[1] 佘守章[1] 邬子林[1] 许立新[1] 

机构地区：[1]广州医学院附属市一人民医院麻醉科,广州510180

出　　处：《广东医学》2006年第11期1608-1610,共3页Guangdong Medical Journal

摘　　要：目的 研究轻比重罗哌卡因与左旋布比卡因用于高龄患者下肢关节置换术连续脊麻的安全性与可行性。方法 择期在连续脊麻下行单侧下肢关节置换术的高龄患者60例，随机分为罗哌卡因（R）组和左旋布比卡因（L）组，每组30例。R组采用0．3％罗哌卡因，L组采用0．3％左旋布比卡因。用Spinoeath导管针（27G）于L2-3，穿刺蛛网膜下腔并置管2～3Cm，以0．1ml／s注入轻比重局麻药4．0ml。观察双侧感觉和运动阻滞时间、双侧最大阻滞平面、维持止痛时间、运动恢复时间、最大Bromage评分、局麻药用量和输液输血量。记录平均动脉压、心率、呼吸、血氧饱和度、并观察不良反应。结果 R组感觉阻滞起效时间和运动阻滞时间均比L组慢（P〈0．01）；两组最大阻滞平面均呈现手术侧显著高于健侧（P〈0．001）；R组维持止痛时间和运动恢复时间均比L组缩短（P〈0．01）；R组最大Bromage的3级构成比明显小于L组（P〈0．05）；R组局麻药用量显著多于L组（P〈0．01）。两组血液动力学变化与其术前比较差异无显著性（P〉0．05）；两组术中和术后不良反应较少，且组间比较差异无显著性（P〉0．05）。结论 轻比重罗哌卡因与左旋布比卡因用于高龄患者下肢关节置换手术的连续脊麻均安全有效。Objective To investigate the feasibility and safety of continuous spinal anesthesia for lower llmb joint replacement in elderly patients with hypobarie ropivaeaine and levobupivacaine. Methods Sixty elderly patients （ ASA Ⅰ～Ⅲ ） scheduled for lower limb joint replacement with continuous spinal anesthesia were randomly divided into group R and group L equally. Patients in group R received 0.3% hypobarie ropivacaine 4 ml by spinal anesthesia and patients in group B received 0.3% hypobarie levobupivacaine 4 ml by spinal anesthesia. Onset time of sensory block, upper sensory level, time to maximal degree of motor block, duration of analgesia and regression of Bromage 0 were investigated. Mean arterial pressure, heart rate, respiratory rate, oxygen saturation, consumption of local anesthetics and side effects were recorded. Results Onset of sensory block and motor block were slower in group R than those in group L（ P 〈 0.01 ） ;Upper sensory level at the side of surgery in the two groups was higher than another side （ P 〈 O. 001 ） ; Duration of analgesia and motor recovery were shorter in group R than those in group L（ P 〈 0.01 ） ;The ratio of Bromage 2 and Bromage 3 was lower in group R than that in group L（ P 〈 0.05） ; Consttmption of local anesthetics was more in group R than group L（ P 〈 0.01 ）. There were no significant hemedynamie changes in the two groups compared with baseline values （ P 〉 0.05） ;The ineidenxes of side effects during and after operation were low and there were no significant differences between the two groups. （ P 〉 0.05）. Conclusion Continuous spinal anesthesia with hypobarie ropivaeaine and levobupivaeaine is safe and effective for lower limb joint replacement in elderly patients.

关 键 词：老年人 连续脊麻 罗哌卡因 左旋布比卡因 

分 类 号：R614.4[医药卫生—麻醉学]