重比布比卡因单侧脊麻在老年人工全膝关节置换术的最低有效剂量研究  

A study on the minimum local analgesic dose of single lateral spinal anesthesia with hyperbaric bupivacaine in agedness total knee arthroplasty

作　　者：曹振刚[1] 彭深渠[1] 古昌剑 张淑芳[1] 袁媛[1] 张新峰[1] CAO Zhengang;PENG Shenqu;GU Changjian;ZHANG Shufang;YUAN Yuan;ZHANG Xinfeng(Departraent of Anesthesiology of the First Division Hospital of Xinjiang Production and Construction Corps, Xingjiang A.ksu 843000, Chin)

机构地区：[1]新疆生产建设兵团第一师医院麻醉科,新疆阿克苏843000

出　　处：《新疆医学》2018年第2期149-152,共4页Xinjiang Medical Journal

基　　金：2016年新疆生产建设兵团第一师市科研与推广计划项目(2016YL03)

摘　　要：目的采用序贯法测定重比重布比卡因单侧脊麻用于老年人工全膝关节置换术中布比卡因的最低有效剂量(minimum local analgesic dose,MLAD)。方法选择符合纳入标准在我院行人工全膝关节置换术的老年患者40例,取患侧向下侧卧位,于L3~4间隙穿刺行硬膜外穿刺,成功后采用25#细针行蛛网膜下腔穿刺给药(腰穿针缺口朝受试者患侧肢体方向给药,给药速度0.1 ml/s),给药后硬膜外置管,继续侧卧15 min后取平卧位,评价麻醉效果。每次根据麻醉效果调整局麻药液(0.75%布比卡因2 mL+10%葡萄糖注射液1 mL)用量,第一个病人给予重比重布比卡因10 mg。若上一个病人镇痛良好,改良Bromage运动阻滞分级法评为1~3分,双侧麻醉平面相差≥4个阶段为成功有效,则下一个患者的布比卡因用量减少0.5 mg;反之则下一个患者的布比卡因用量增加0.5 mg。结果老年患者重比重布比卡因单侧脊麻的MLAD为8.69 mg,95%可信区间为(6.81~10.57)mg。结论采用序贯法测定重比重布比卡因单侧脊麻用于老年膝关节置换术中布比卡因的最低有效剂量是8.69 mg。Objective To determine the minimum local analgesic dose（minimum local analgesic dose, MLAD） of bupivacaine in agedness knee arthroplasty by sequential method. Methods In accordance with the inclusion criteria in 40 elderly patients were underwent knee arthroplasty agedness had lower lateral decubitus, L3~4 gap puncture for epidural puncture, after the success of using 25# fine needle puncture subarachnoid administration（lumbar puncture gap toward the subjects of ipsilateral limbs the direction of delivery, delivery speed of 0.1 ml/s）, after Administration of epidural catheter, supine position to continue after 15 min, the effect of anesthesia evaluation. The dosage of local anesthetic solution（0.75% bupivacaine 2 mL＋10%Glucose injection 1 mL） was adjusted according to anesthetic effect. The first patient was given 10 mg of gravity specific bupivacaine. If first patient＇s effect of anaesthesia was satisfactory, the modified Bromage motor block classification was 1~3, bilateral difference over 4 stages of anesthesia were succeed, the next bupivacaine dosage decrease 0.5 mg; otherwise the next dose of bupivacaine increased 0.5 mg. Each time dose increased/decreased by equivalent dose, was 0.5 mg. Results The MLAD of the elderly patients with heavy proportion of bupivacaine on unilateral spinal anesthesia was 8.69 mg, and the 95% confidence interval was（6.81~10.57） mg. Conclusion The minimum local analgesic dose of bupivacaine for total knee arthroplasty with hyperbaric bupivacaine is 8.69 mg by sequential method.

关 键 词：人工全膝关节置换术 椎管内麻醉 剂量 

分 类 号：R589.3[医药卫生—内分泌]