轻比重罗哌卡因腰麻用于老年病人人工关节置换术的量-效关系  

Dose-effect relationship of hypobaric ropivacaine in spinal anesthesia in the elderly undergoing hip replacement

作　　者：王心田[1] 马武华[1] 李荣胜[1] 黎玉辉[1] 翁碧峰[2] 刘唐生[2] 

机构地区：[1]广州中医药大学第一附属医院麻醉科,510405 [2]广州市白云区中医医院麻醉科

出　　处：《临床麻醉学杂志》2008年第1期23-25,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨轻比重罗哌卡因腰麻用于老年病人人工关节置换术的量-效关系。方法选择70～98岁的人工关节置换术病人75例，随机均分为三组。用Spinocath 24G导管针于L3～4椎间隙穿刺，蛛网膜下腔置管2．0～2．5cm。Ⅰ、Ⅱ、Ⅲ组依次应用0．3％、0．4％、0．5％罗哌卡因轻比重（1．001～1．002，20℃）腰麻液1．0～1．2ml。观察镇痛起效时间、运动阻滞起效时间、最高痛觉阻滞平面、麻醉持续时间、最大运动阻滞程度、痛觉及运动恢复时间、阻滞完全病人比例及用药后的不良反应。结果三组镇痛起效时间、最高痛觉阻滞平面、完全阻滞病人比例（Ⅰ组2例痛觉阻滞不全）差异无统计学意义；运动阻滞起效时间Ⅲ组比Ⅰ组短（P〈0．01），麻醉持续时间、最大Bromage评分、痛觉和运动恢复时间Ⅲ组〉Ⅱ组〉Ⅰ组（P〈0．05或P〈0．01）。三组均出现单侧下肢阻滞。结论0．4％罗哌卡因轻比重液4．0～4．8mg腰麻用于老年病人人工关节置换术，可达到完善的镇痛效果，且较安全。Objective To investigate the dose-effect relationship of hypobaric ropivacaine in spinal anesthesia in the elderly undergoing hip replacement. Methods Seventy-five patients, aged 70 to 98 years and scheduled for hip replacement, were randomly allocated to three groups with 25 cases each. A 24-gauge Spinocath catheter was advanced 2. 0-2.5 cm into subarachnoid space at L3-4 interspace. The patients in group Ⅰ, Ⅱ and Ⅲ were given 1.0-1.2 ml of 0.3%, 0. 4% or 0.5% hypobaric （1. 001-1. 002,20℃） ropivacaine solution, respectively. Motor and sensory blockade was evaluated,and adverse effects were recorded. Results There was no significant difference in sensory block including onset time and maximum cephalad spread level among three groups. The complete sensory block appeared in most patients except for 2 cases in group Ⅰ. The onset time and duration of motor blockage in group Ⅲ were shorter than those in group Ⅰ（P〈0.05）. The maximum Bromage＇s score,duration of anesthesia, sensory or motor regressive time in group Ⅱ were more than those in group Ⅰ,but less than those in group Ⅲ （P〈0.05 or P〈0.01）. The blockade of single leg occurred in all patients. Conclusion Continuous spinal anesthesia with 0.4% hypobaric ropivacaine 4.0-4.8 mg is safe and effective for hip replacement surgery in eldly patients.

关 键 词：罗哌卡因 腰麻 老年人 关节成形术 量-效关系 

分 类 号：R614[医药卫生—麻醉学]