不同小剂量低浓度罗哌卡因用于老年患者腰一硬联合麻醉的研究  

Application of different low dose and concentration ropivacaine in spinal-epidural anesthesia for elderly patients

作　　者：吴秀玲[1] 姜曙祥 王新闻[1] 

机构地区：[1]新疆石河子市人民医院麻醉科,832000 [2]急外科

出　　处：《临床外科杂志》2013年第2期128-130,共3页Journal of Clinical Surgery

摘　　要：目的观察不同小剂量罗哌卡因用于老年患者腰-硬联合麻醉对下肢手术的可行性。方法择期下肢手术的老年患者120例，随机分为三组，每组40例。A组：0．5％罗哌卡因5—7．5mg＋10％葡萄糖0．5ml；B组：0．75％罗哌卡因5—7．5mg＋10％葡萄糖0．5ml；C组：0．75％罗哌卡因8～10mg＋10％葡萄糖0．5ml。观察感觉阻滞、运动阻滞起效时间和最高时间，最高麻醉阻滞平面，痛觉及运动阻滞维持时间，不良反应及血流动力学等。Bromage法评定运动神经阻滞程度。连续监测SBP、DBP、HR、SpO：、ECG。结果随着罗哌卡因浓度剂量的降低，感觉、运动阻滞起效时问和最大阻滞时间延长，维持时间缩短；与C组比较，A、B组感觉、运动阻滞起效时间、最大时间、维持时间差异均有统计学意义（P〈0．05），A与B组比较差异无统计学意义（P〉0．05）。三组运动阻滞的Bromage评分组差异无统计学意义（P〉0．05）。术中低血压使用麻黄碱A组为0，B、C组均使用麻黄碱，但这两组比较差异无统计学意义（P〉0．05），三组均未发生呕吐、头痛和神经系统症状。结论0．5％罗哌卡因5—7．5mg＋10％葡萄糖0．5ml配方可安全应用于蛛网膜下腔阻滞，适应于老年患者下肢手术，是一种较安全有效的麻醉方法。Objective To observe the feasibility and anesthetic effect of different low-dose ropiv- acaine in spinal-epidural anesthesia for elderly patients with lower limb surgery. Methods A total of 120 elderly patients who would receive elective lower limb surgery were randomly divided into 3 groups （ n = 40 each）. Patients received 5 ~7.5 mg of 0.5% ropivacaine plus O. 5ml of 10% glucose in group A,5 -7.5 mg of 0.75% ropivacaine plus 0.5ml of 10% glucose in group B and 8 ~ 10 mg of 0.75% ropivacaine plus 0.5 ml of 10% glucose in group C ; We observed the onset time and maximum time of sensory and motor block, the maximum pain block plane, the lasting time of pain and motor block, side-effects and he- modynamics ; Bromage score was employed to access the degree of motor block ; And we continuously moni- tored SBP,DBP, HR, SpO2 and ECG. Results With the reducing ropivacaine dose, the onset time and maximum time of sensory and motor block increased and the lasting time of pain and motor block de- creased; Compared with group C, the differences of onset time and maximum time of sensory and motor block and the lasting time of pain and motor block in Group A and B were significant （ P 〈 0.05 ）, while the differences between group A and group B in these indicators were not（ P 〉 0.05 ）. There were no sig- nificant differences in Bromage score among the three groups（ P 〉 0.05 ）. When the patients suffered from hypotension,no ephedrine was used in group A;In group B and C, patients received ephedrine but there was no significant difference. No patients had headache, vomit or neurological symptoms in all three groups. Conclusion The formula of 5 - 7.5 mg of O. 5% ropivacaine plus 0.5ml of 10% GS can be used in spinal anesthesia safely, which is a reliable and effective anesthesia method for lower limb surgery in elderly patients.

关 键 词：罗哌卡因 小剂量 腰一硬联合麻醉 老年患者 

分 类 号：R614.42[医药卫生—麻醉学]