等比重布比卡因CSEA在高龄患者髋关节置换术麻醉中的应用  

Isobaric bupivacaine CSEA in senile patients with hip joint replacement surgery anesthesia advantages

作　　者：李俊凯[1] 刘旭[1] 朱云章[1] 

机构地区：[1]沈阳市骨科医院麻醉科,辽宁沈阳110044

出　　处：《局解手术学杂志》2013年第2期142-144,共3页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨等比重布比卡因腰-硬联合麻醉(CSEA)在高龄患者髋关节置换术中应用的可行性、安全性及有效性。方法 60例髋关节置换术的高龄患者,年龄(88±7)岁,ASAⅠ～Ⅲ级,随机分为2组,每组30例,Ⅰ组为腰-硬联合麻醉组(CSEA),Ⅱ组为连续硬膜外麻醉组(EA)。Ⅰ组局麻药为0.75%布比卡因1.33 mL(布比卡因10 mg),Ⅱ组硬膜外试验用药为1.5%利多卡因3 mL,维持药物为0.5%罗哌卡因。分别记录2组患者的麻醉起效时间、麻醉完善时间、麻醉并发症,记录麻醉前(T0)、麻醉后(T1)及用药后5 min(T2)、15 min(T3)、30 min(T4)、60 min(T5)的MAP、HR、SpO2和RR。结果Ⅰ组麻醉显效时间为(44.0±10.3)s,Ⅱ组为(360.0±60.4)s,2组比较P<0.05,差异具有统计学意义。Ⅰ组病例术中生命体征平稳,虽个别病例出现血压降低,但均小于基础值20%。Ⅱ组3例麻醉平面超过T10,血压下降大于基础值30%,需用麻黄碱纠正。术后随访72 h,2组均无麻醉并发症。结论等比重布比卡因CSEA在高龄患者髋关节置换术中效果确切,是一种安全、简便、有效的麻醉方法。Objective To investigate the feasibility, safety and effectiveness of isobaric bupivacaine in combined spinal-epidural anes- thesia （CSEA） for senile patients undergoing hip replacement surgery. Methods 60 cases of senile patients aged （88 ±7 ） years with hip replacement were randomly divided into two groups （30 cases each group）, group Ⅰ were conducted combined spinal-epidural anesthesia （CSEA） and group Ⅱ were conducted continuous epidnral anesthesia （EA）. Local anesthetics of group Ⅰ was 0.75% bupivacaine 1.33 mL （bupivaeaine 10 mg） ;epidural test medication of group Ⅱ was 1.5% lidocaine 3 mL, and maintenance medication was 0.5% ropivacaine. Respectively record the anesthetic onset time, anesthesia time, the anesthetic complications, and the MAP, HR, SpO2 and RR before anesthesia （ TO ）, after anesthesia （ TI ） and after the anesthesia of 5 min （ T2 ）, 15 min （ T3 ）, 30 rain （ T4 ） ,60 rain （ T5 ）. Results The anesthetic on- set time of group Ⅰ was （44 ±10.3 ） s, and group Ⅱ was （360 ± 60.4） s, the difference was of statistical significance （ P 〈 0.05 ）. The pa- tients of group ｜ were in stable vital signs during the surgery, although blood-pressure reduction appeared in a few patients, they were all less than 20% of the base value. Level of anesthesia wider than T10 occurred in 3 cases of patientsin group Ⅱ ,and the blood-pressure decreased more than 30% of the base value which requires ephedrine correction. In the follow-up of 72 hours, there was no anesthetic complications. Conclusion Isobaric bupivacaine CSEA has an exact effect for aged patients in hip joint replacement, and it is a safe, simple, effective anes- thesia method.

关 键 词：等比重布比卡因 腰-硬联合麻醉 高龄患者 髋关节置换术 

分 类 号：R614.4[医药卫生—麻醉学]