轻比重腰麻与神经阻滞麻醉在老年髋关节手术中的应用  

Application of hypobaric ropivacaine spinal anesthesia and nerve block anesthesia in hip surgery of elderly patients

作　　者：郝春香[1] 韩春姬[1] 陈国庆 刘舒云[1] 张昌盛[1] 北京市[1] Hao Chun-xiang;Han Chun-ji;Chen Guo-qing;Liu Shu-yun;Zhang Chang-sheng(Anesthesia and Operation Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院麻醉手术中心,北京市100853

出　　处：《中国组织工程研究》2018年第7期1009-1013,共5页Chinese Journal of Tissue Engineering Research

基　　金：863计划生物和医药技术领域组织工程关键技术与系列产品研发主题项目(2012AA020502),课题名称:肢体重要组织损伤组织工程修复重建技术研发

摘　　要：背景:合理选择老年患者髋部手术的麻醉方法不仅保障了手术的顺利进行,而且可以明显降低术后并发症的发生率。目的:比较腰丛神经阻滞+坐骨神经阻滞和轻比重罗哌卡因腰麻在老年患者髋关节手术中的麻醉效果。方法:纳入40例拟行髋关节手术的老年患者,年龄65-99岁,美国麻醉医师协会分级Ⅱ-Ⅲ级,随机分为神经阻滞组和轻比重腰麻组,每组各20例。神经阻滞组采用超声引导+神经刺激仪刺激下的腰丛神经阻滞+坐骨神经阻滞;轻比重腰麻组于L3-4间隙穿刺,给予轻比重罗哌卡因单次腰麻。观察两组患者麻醉前后血流动力学变化、麻醉效果以及围术期不良反应的发生情况。结果与结论:(1)麻醉前后相比较,神经阻滞组与轻比重腰麻组患者在麻醉后各时点的心率、平均动脉压差异均无显著性意义(P>0.05);(2)轻比重腰麻组的麻醉起效时间更快(P<0.01),术中镇痛效果更加完善,无需静脉药物辅助;神经阻滞组运动与感觉阻滞时长较轻比重腰麻组长(P<0.01),但有5例患者需要在静脉麻醉药物的辅助下完成手术;(3)两组患者均无不良反应发生;(4)提示相比神经阻滞麻醉,轻比重腰麻应用于老年髋关节手术患者可获得更为完善的镇痛效果以及稳定的血液循环,且不增加并发症的发生率,有较好的临床应用价值。BACKGROUND:The rational choice of anesthesia for the elderly patients with hip surgery not only ensures the smooth operation,but also significantly reduces the incidence of postoperative complications.OBJECTIVE:To compare the clinical anesthetic effects between combined lumbar plexus-sciatic nerve block and hypobaric ropivacaine spinal anesthesia in hip joint surgery of elderly patients.METHODS:Forty patients who were scheduled for hip joint surgery,at the age of 65-99 years old,American Society of Anesthesiologists grades II-III,were enrolled and randomly allocated to two groups:nerve block(n=20)and spinal anesthesia(n=20).In nerve block group,combined lumber plexus-sciatic nerve block was performed directed by a nerve stimulator under the guidance of ultrasound.In spinal anesthesia group,patients received single-dose hypobaric ropivacaine spinal anesthesia at L3-4 interspace.Hemodynamic changes,anesthetic effects and perioperative adverse effects were recorded in both groups before and after anesthesia.RESULTS AND CONCLUSION:(1)The patients’heart rate and mean artery pressure in each group did not change significantly before and after anesthesia in the nerve block and spinal anesthesia groups(P>0.05).(2)The onset time of anesthesia in spinal anesthesia group was significantly faster than that in nerve block group(P<0.01).Hypobaric ropivacaine spinal anesthesia had a better analgesic effect during the surgery,which did not need extra intravenous anesthetics.The duration of motor and sense block was significantly longer in nerve block group than in spinal anesthesia group(P<0.01).However,five patients in spinal anesthesia group needed extra intravenous anesthetics to finish the surgery.(3)No side effects were found in both nerve block and spinal anesthesia groups.(4)These indicated that compared to combined lumbar plexus-sciatic nerve block,hypobaric ropivacaine spinal anesthesia can provide a better analgesic effect during the hip joint surgery with stable hemodynamics.Moreover,hypobaric ropivacaine spinal ane

关 键 词：麻醉 髋关节 组织工程 

分 类 号：R318[医药卫生—生物医学工程]