重比重罗哌卡因用于老年蛛网膜下腔麻醉  

The safety and efficacy of spinal anaesthesia with hyperbaric ropivacaine solutions in the elderly

作　　者：张红光[1] 宫本航[1] 鹿洪秀[1] 李智帅[1] 

机构地区：[1]山东中医药大学附属医院麻醉科,济南市250011

出　　处：《临床麻醉学杂志》2008年第9期763-764,共2页Journal of Clinical Anesthesiology

摘　　要：目的研究重比重罗哌卡因用于老年患者蛛网膜下腔阻滞的安全性和有效性。方法择期肛门会阴部手术老年患者120例,ASA Ⅰ或Ⅱ级。随机分为三组,每组40例。于 L_(3～4)间隙穿刺。注药时患者取坐位,以0.2 ml/s 的速度分别注入重比重混合局麻药。用针刺法测感觉阻滞平面.用改良 Bromage 法评估下肢运动神经阻滞程度.以患者提肛收缩肛门和指诊观察肛门括约肌阻滞程度。比较三组患者在感觉、运动阻滞及恢复上的异同,记录血压、心率变化及不良反应。结果三组均能达到感觉阻滞。但 R_1组肛门括约肌阻滞不完善者多于 R_2、R_3组(P<0.01);R_2组下肢运动神经阻滞起效时间长于 R_3组(P<0.01);运动阻滞恢复时间短于 R_2组(P<0.01);R_2组感觉阻滞消退到 S_(1～2)时间、完全下肢运动神经阻滞发生率及尿潴留发生率明显少于 R_3组(P<0.01)。结论罗哌卡因重比重液6 mg 于老年患者应用蛛网膜下腔麻醉安全有效.并发症少。Objective To study the safety and efficacy of spinal anaesthesia with hyperbaric ropivacaine solutions in the elderly. Methods One hundred and twenty ASA grade Ⅰ - Ⅱ patients undergoing elective perineal and anal surgery were randomized to three groups with 40 cases each. Lumbar puncture was performed at L3-4 intervertibral space. Hyperbaric solutions of ropivacaine 4 mg （group R1 ） ,6 rag（group R2 ） and 8 mg （group R3 ） were injected at the speed of 0. 2 ml/s with the patient in sitting position. Needling method was used for sensory block assessment, modified Bromage scale was used for evaluating motor block and digital examination as well as drawing up the anus was used for anal sphincter block assessment. Blood pressure, heart rate and side effects were recorded. Results Sensory block was achieved in all three groups. The number of imperfect anal sphincter block was more in group R1 than that in groups R2 and R3 （P〈0. 01）. Motor block was less in group R2 than that in group R3 （P〈0.01）,but the patients in group R2 had a shorter recovery time of motor block and less urine retention compaered with those in group R3 （P〈 0.01 ）. Conclusion Spinal anaesthesia with 6 mg of hyperbaric ropivacaine solution in the elderly is safe and effective with less complication.

关 键 词：腰麻 罗哌卡因 老年 蛛网膜下腔 

分 类 号：I2671.007[文学—中国文学]