小剂量轻比重不同浓度罗哌卡因单侧腰—硬联合麻醉在老年患者全髋关节置换术中的应用  

Lateral combined spinal- epidural anesthesia with hypobaric ropivacaine of small dose and different concentrations applied in elderly patients treated with total hip arthroplasty

作　　者：涂琴琴[1] 

机构地区：[1]黄石市中心医院麻醉科,湖北黄石435000

出　　处：《安徽医药》2016年第1期163-166,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的：观察不同浓度的小剂量轻比重罗哌卡因应用于单侧腰—硬联合麻醉在老年患者全髋关节置换术效果及安全性。方法选择该院于2014年1月—2015年4月收治的需行全髋关节置换术老年患者60例作为研究对象，均符合手术指证， ASA 分级Ⅰ～Ⅱ级，按照配对分组法分为三组，每组20例，三组患者均选择 L3－4作为穿刺节段，A 组给与0．15％罗哌卡因2．5 mL，B 组给与0．25％罗哌卡因2．5 mL，C 组给与0．5％罗哌卡因2．5 mL，比较三组患者效果，并统计不良反应发生率。结果A 组、B 组两组比较，麻醉前、麻醉后及术毕平均动脉压（MAP）及心率（HR）均无显著统计学差异，均 P ＞0．05；C 组麻醉后及术毕平均动脉压 MAP 均显著低于 A 组、B 组，HR 显著高于 A 组、B 组，均 P ＞0．05。B 组平面消退时间、运动阻滞恢复时间均高于 A 组，低于 C 组，均 P ＜0．05；B 组运动阻滞起效时间低于 A 组，高于 C 组，均 P ＜0．05。B 组不良反应5例（25．0％）与 A组2例（10．0％）比较，差异无统计学意义，P ＞0．05；A 组、B 组不良反应发生率显著低于 C 组，均 P ＜0．05。三组患者呼吸频率（RR）及潮气量（Vt）比较均无显著统计学差异，P ＞0．05。结论0．25％罗哌卡因2．5ml 轻比重罗哌卡因应用于单侧腰—硬联合麻醉在老年患者全髋关节置换术效果较佳，且不良反应发生率低，具有重要临床价值。Objective To observe effect and safety of lateral combined spinal -epidural anesthesia with hypobaric ropivacaine of small dose and different concentrations applied in elderly patients treated with total hip arthroplasty.Methods We selected 60 cases of eld-erly patients treated with total hip arthroplasty in Huangshi Center Hospital from January 2014 to April 2015 as research objects.All patients were in line with the indications for surgery with ASA gradeⅠ ~Ⅱ.Then according to paired grouping method they were as-signed into three groups with 20 cases in each group.L3 -4 was selected as puncture segment in all patients of the three groups.Group A was given 0.15% ropivacaine 2.5 mL,group B 0.25% ropivacaine 2.5 mL,group C 0.5% ropivacaine 2.5 mL.Effect and ad-verse reaction incidence were compared among patients.ResultsBetween group A and group B before anesthesia,after anesthesia and postoperation mean arterial pressure （MAP）and heart rate （HR）had no significant difference （P 〉0.05）.After anesthesia and post-operation mean arterial pressure （MAP）in group C was significantly lower than in group A,group B and HR was significantly higher than in group A and group B （P 〉0.05）.The regression time and recovery time of motion blockade in group B was higher than that in group A while lower than that in group C （P 〈0.05）.The onset time of motion blockade in group B was lower than that in group A while higher than that in group C （P 〈0.05）.There were no significant differences in adverse reactions between group B （5 cases, 25%）and group A （2 cases,10.0%）（P 〉0.05）.Incidences of adverse reactions in group A and group B were significantly lower than that in C group （P 〈0.05）.There were no statistically significant difference in respiratory rate （RR）and tidal volume（Vt）a-mong three groups （P 〉0.05）.Conclusions The application of 2.5 ml of 0.25% ropivacaine to combined spinal -epidural anesthe-sia in elderly patients treated with total hip arthroplasty ha

关 键 词：腰-硬联合麻醉 小剂量 轻比重 罗哌卡因 全髋关节置换术 

分 类 号：R614[医药卫生—麻醉学]