老年髋关节置换与腰麻复合腰丛阻滞麻醉  

Elderly hip replacement and isobaric spinal anesthesia in combination with lumbar plexus anesthesia

作　　者：宋海明[1] 杜宁[1] 

机构地区：[1]唐山市第二医院麻醉科,河北省唐山市063000

出　　处：《中国组织工程研究与临床康复》2010年第26期4858-4861,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:探讨等比重腰麻复合腰丛麻醉在老年髋关节手术中的应用。方法:以"腰麻,髋关节置换"为中文关键词,检索2000-01/2010-03相关文章。纳入与腰麻与髋关节置换相关研究文献;排除重复研究。以11篇文献为主重点进行讨论。并选择择期行髋关节置换患者50例作为临床验证。采用等比重腰麻复合腰丛麻醉,维持患者侧卧位至术毕,观察麻醉前及麻醉后5,15,30min的血流动力学变化及心率的变化,观察两侧痛觉阻滞平面,温度觉及触觉平面,Bromage运动阻滞评分,术中不良反应,患肢有效的镇痛时间及有效的阻滞时间。结果:目前老年髋关节置换常用的麻醉方法有罗哌卡因单侧腰麻-硬膜外联合麻醉,左旋布比卡因复合舒芬太尼腰硬联合麻醉,连续硬膜外阻滞联合小剂量布比卡因腰麻等方法,研究表明联合麻醉效果好于单纯用药。经临床验证结果,采用等比重腰麻复合腰丛麻醉,麻醉后各时间的血流动力学及心率的变化与麻醉前比较差异无显著性意义。患侧痛觉阻滞平面,温度觉及触觉阻滞平面,Bormage运动阻滞评分与健侧比较差异有显著性意义(P<0.01)。术中呕吐1例,低血压6例,患肢的有效镇痛时间及有效阻滞时间分别为(5.5±2.2)h和(2.5±0.5)h。结论:等比重腰麻复合腰丛麻醉在老年髋关节置换术中的应用是安全可靠的,对全身生理干扰小的麻醉方法。OBJECTIVE： To explore isobaric spinal anesthesia in combination with lumbar plexus anesthesia in application of elderly hip joint surgery. METHODS： With lumbar anesthesia, hip replacement as Chinese , articles published between January 2000 and March 2010 were searched. Articles related with lumbar anesthesia, hip replacement were included. Repetitive studies were excluded. Finally, 11 articles were discussed, and 50 patients selectively undergoing hip replacement were selected as clinical validation. Using isobaric spinal anesthesia in combination with lumbar plexus anesthesia, the patients were maintained in lateral position. Hemodynamics and heart rate changes before, and 5, 15, 30 minutes after anesthesia were observed. Bilateral algesia blocking plane, temperature sense and touch sensation, Bromage motor blocking score, adverse effects, effective analgesia time and effective blocking time of affected limbs were investigated. RESULTS： Currently used anesthesia methods for the elderly hip replacement include ropivacaine lateral combined spinal epidural anesthesia, levobupivacaine in combination with sufentanil combined spinal epidural anesthesia, continuous epidural anesthesia in combination with low-dose bupivacaine lumbar anesthesia. Studies have shown that combined anesthesia displays better than medication alone. Clinical results show that hemodynamics and heart rate remained unchanged following isobaric spinal anesthesia in combination with lumbar plexus anesthesia. Algesia blocking plane, temperature sense and touch sensation, Bromage motor blocking score of lesioned side displayed significant differences compared with normal side （P〈0.01）. In addition, 1 case developed vomiting and 6 hypotension. The effective analgesia time and effective blocking time of affected limbs were （5.5±2.2） hours and （2.5±0.5） hours were investigated. CONCLUSION： Isobaric spinal anesthesia in combination with lumbar plexus anesthesia is safe and reliable in elderly hip replacement with little phy

关 键 词：髋关节置换 腰麻 腰丛阻滞 老年 硬组织植入物 

分 类 号：R318[医药卫生—生物医学工程]