老年髋关节置换应用等比重布比卡因复合腰丛阻滞  

Lumbar plexus block combined with isobaric bupivacaine anesthesia in elderly total hip replacement

作　　者：康凯[1] 张西京[1] 熊利泽[1] 

机构地区：[1]解放军第四军医大学西京医院麻醉科,陕西省西安市710032

出　　处：《中国组织工程研究与临床康复》2010年第39期7394-7397,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：国家自然科学基金(30772074)~~

摘　　要：背景:以往老年患者行髋关节置换的麻醉主要为全麻,腰麻,硬膜外麻醉。单纯腰麻容易造成麻醉平面和麻醉时间的局限。目的:对比观察等比重布比卡因腰麻复合腰丛阻滞和连续硬膜外阻滞联合小剂量布比卡因腰麻在老年髋关节手术中的应用效果。方法:行髋关节置换术高龄患者46例,随机分为两组,分别给予患侧腰丛阻滞复合等比重布比卡因腰麻和连续硬膜外阻滞联合小剂量布比卡因腰麻,比较麻醉前、麻醉后5,10,15,20,30min收缩压、舒张压、心率及血氧饱和度,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。结果与结论:采用等比重腰麻复合腰丛麻醉,麻醉前与麻醉后各时间点收缩压、舒张压、心率、血氧饱和度比较差异无显著性意义(P>0105),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)。等比重布比卡因腰麻复合腰丛阻滞患肢的有效镇痛时间及有效阻滞时间均长于连续硬膜外阻滞联合小剂量布比卡因腰麻。提示等比重布比卡因腰麻复合腰丛阻滞用于高龄髋关节置换术起效快、不改变麻醉体位、循环稳定,减少了腰麻用药量,麻醉平面更易控制,更安全。BACKGROUND：The anesthesia for elderly hip replacement mainly includes general anesthesia,lumbar anesthesia,and epidural anesthesia. Lumbar anesthesia alone could induce limitations in anesthesia plane and duration. OBJECTIVE：To observe the effect of lumbar plexus blocking combined with isobaric bupivacaine anesthesia versus epidural anesthesia in total hip replacement. METHODS：A total of 46 elder patients undergoing hip replacement were divided into two groups,and were anesthetized using lumbar plexus blocking combined isobaric bupivacaine or epidural anesthesia combined low-dose bupivacaine. Systolic blood pressure （SBP）,diastolic blood pressure （DBP）,heart rate （HR）,and pulse oxygen saturation （spo2） were compared before,5,10,15,20,30 minutes after anesthesia. Algesthesia block level,temperature sensation,Bromage score were observed. Adverse reactions,effective analgesia duration and blocking duration were recorded. RESULTS AND CONCLUSION：There was no significant difference in SBP,DBP,HR,in lumbar plexus block combined isobaric bupivacaine anesthesia before and after anesthesia （P 0.05）. There was significant difference in block level,temperature sensation,Bromage score between affected limbs and normal limbs （P 0.01）. Lumbar plexus block combined isobaric bupivacaine anesthesia exhibited longer effective analgesia duration and blocking duration compared with epidural anesthesia combined with low-dose bupivacaine,demonstrating lumbar plexus block combined isobaric bupivacaine anesthesia is safe and controllable in total hip replacement,which reduces drug dose,does not change anesthesia body position,with stable circulation.

关 键 词：髋关节置换 腰麻 腰丛阻滞 老年 等比重布比卡因 

分 类 号：R318[医药卫生—生物医学工程]