改良脊椎-硬膜外联合阻滞法用于高龄患者膝关节置换术的可行性  

Feasibility of using modified combined spinal-epidural anesthesia in elderly patients undergoing total knee arthroplasty

作　　者：林华阳[1] 饶福东[1] 林洁[1] 修忠标[2] 林翔[2] 李师阳[3] 杨锡馨[1] 卢希[1] 

机构地区：[1]福建中医药大学附属人民医院麻醉科, 福州市350004 [2]福建中医药大学附属人民医院骨科, 福州市350004 [3]福建医科大学泉州市妇幼保健院&儿童医院麻醉科

出　　处：《中华麻醉学杂志》2013年第12期1458-1460,共3页Chinese Journal of Anesthesiology

基　　金：福建省教育厅科技项目基金资助课题（JB11070）;福建中医药大学附属人民医院临床技术创新课题（CXZD1301）

摘　　要：目的 初步评价脊椎-硬膜外联合阻滞改良法用于高龄患者膝关节置换术的可行性.方法 高龄患者30例,拟行单侧膝关节置换术,性别不限,ASAⅡ或Ⅲ级,肝肾功能无严重异常,无椎管内麻醉禁忌证.采用脊椎-硬膜外联合阻滞改良法：蛛网膜下腔穿刺成功后,将1％盐酸罗哌卡因18 mg与脑脊液分4次混合稀释,向尾侧分次注入蛛网膜下腔;向硬膜外腔头侧注入生理盐水5ml,并免除置入硬膜外导管.观察麻醉期间BP、ECG、HR、RR、SpO2、感觉阻滞起效时间、运动阻滞程度、每小时尿量、术者对麻醉的满意度.结果 感觉阻滞起效时间（16＆#177;6）s,运动阻滞程度Bromage评级为Ⅱ级或Ⅲ级,术者对麻醉满意率100％;阻滞平面均在T9以下,麻醉期间尿量未见异常,RR、SpO2、BP及HR维持在正常范围.结论 采用1％盐酸罗哌卡因18 mg行改良法脊椎-硬膜外联合阻滞,起效迅速、麻醉效果满意,对循环、呼吸功能无明显不良影响,适用于高龄患者膝关节置换术.Objective To primarily evaluate the feasibility of using modified combined spinal-epidural anesthesia in elderly patients undergoing total knee arthroplasty.Methods Thirty elderly patients of both sexes,ASA physical status Ⅱ or Ⅲ,scheduled for elective unilateral total knee arthroplasty,without serious abnormal functions of liver and kidney and contraindications against spinal anesthesia,were enrolled in the study.The modified combined spinal-epidural anesthesia was used as follows：after a catheter was successfully placed into the subarachnoid space,1% ropivacaine hydrochloride 18 mg was gradually mixed with the cerebrospinal fluid four times and the mixture was separately injected into the subarachnoid space caudally; normal saline 5 ml was injected into the epidural space in cephalad direction without placement of an epidural catheter.The invasive blood pressure,ECG,HR,RR and SpO2 during anesthesia,onset time of sensory block,degree of motor block,urine volume per hour and surgeon＆#39;s satisfaction with anesthesia were recorded.Results The onset time of sensory block was （16 ＆#177; 6） s.Bromage scale for assessment of the degree of motor block was Ⅱ or Ⅲ.The rate of surgeon＆#39; s satisfaction with anesthesia was 100%.The level of block was below T9,and no abnormality was found in the urine volume during anesthesia with BP,HR,RR and SpO2 within the normal range.Conclusion The modified combined spinal-epidural anesthesia with 1% ropivacaine hydrochloride 18 mg provides rapid onset and satisfactory anesthesia without the occurrence of respiratory depression,and thus is suitable for the elderly patients undergoing total knee arthroplasty.

关 键 词：麻醉 脊椎 麻醉 硬膜外 关节成形术 置换 老年人 

分 类 号：R614[医药卫生—麻醉学]