不同剂量轻比重丁哌卡因蛛网膜下腔麻醉在高龄患者髋关节骨折手术中的应用效果  

Effects of subarachnoid anesthesia with different dosages of light specific gravity bupivacaine in elderly patients with hip fracture surgery

作　　者：陈彬[1] 陈 浩 胡彬[1] 罗志锴[1] 刘磊[1] CHEN Bin;CHEN Hao;HU Bin;LUO Zhi-kai;LIU Lei(Department of Anesthesiology,Affiliated Hospital of Yan′an University,Yan′an 716000,China)

机构地区：[1]延安大学附属医院麻醉科,陕西省延安市716000

出　　处：《广西医学》2020年第5期577-580,共4页Guangxi Medical Journal

摘　　要：目的探讨不同剂量轻比重丁哌卡因蛛网膜下腔麻醉在高龄患者髋关节骨折手术中的应用效果。方法选取60例行髋关节骨折手术的高龄患者,随机分成A组、B组、C组,每组20例。3组患者分别采用1.4 mL 0.25%轻比重丁哌卡因、1.8 mL 0.25%轻比重丁哌卡因、2.2 mL 0.25%轻比重丁哌卡因进行蛛网膜下腔麻醉。比较3组患者的感觉神经及运动神经阻滞起效时间、持续时间,以及麻醉后15 min手术侧单侧阻滞发生率、术中追加局麻药的比例及给药后48 h内不良反应发生情况。结果 3组患者感觉神经阻滞起效时间、运动神经阻滞起效时间及麻醉后15 min术侧单侧阻滞发生率差异均无统计学意义(P均>0.05),而3组患者感觉神经阻滞持续时间和运动神经阻滞持续时间均为C组>B组>A组(均P<0.05)。A组术中追加硬膜外麻醉药的比例均高于B组与C组(均P<0.05),而B组与C组之间差异无统计学意义(P>0.05);C组术中低血压发生率高于B组(P<0.05),而A组与B组之间差异无统计学意义(P>0.05);3组患者均无寒战和术后头痛发生,且心动过缓、恶心呕吐及术后腰背痛发生率均无统计学差异(均P>0.05)。结论在高龄患者髋关节骨折手术中采用1.8 mL 0.25%轻比重丁哌卡因腰麻液进行蛛网膜下腔麻醉,可获得满意的麻醉效果,保持血流动力学稳定,且不良反应少。Objective To explore the effects of subarachnoid anesthesia with different dosages of light specific gravity bupivacaine in elderly patients with hip fracture surgery. Methods Sixty elderly patients undergoing hip fracture operation were randomly divided into group A, group B and group C, with 20 cases in each group. Patients in the three groups received subarachnoid anesthesia with 1.4 mL 0.25% light specific gravity bupivacaine, 1.8 mL 0.25% light specific gravity bupivacaine, and 2.2 mL 0.25% light specific gravity bupivacaine, respectively. The onset time and acting duration of sensory nerve and motor nerve block were compared among the three groups, and the incidence rate of unilateral block on the operation side 15 minutes after anesthesia, the proportion of additional use of local anesthetics during operation, and the incidence of adverse reactions within 48 hours after administration were compared as well. Results There was no statistically significant difference among the three groups in onset time of sensory nerve block, onset time of motor nerve block, or incidence rate of unilateral block on the operation side 15 minutes after anesthesia(all P>0.05), moreover, the acting durations of sensory nerve block and motor nerve block decreased in sequence of group C, group B and group A(all P<0.05). Group A obtained a higher proportion of additional use of epidural anesthetics during operation than group B or C(all P<0.05), but there was no statistically significant difference between group B and group C(P>0.05);group C had a higher incidence rate of intraoperative hypotension than group B(P<0.05), but there was no statistically significant difference between group A and group B(P>0.05);among the three groups, no shivering or postoperative headache occurred, there was no statistically significant difference in incidence rate of bradycardia, nausea, vomiting or postoperative low back pain(all P>0.05). Conclusion Subarachnoid anesthesia with 1.8 mL 0.25% light specific gravity bupivacaine spinal anesthesia solut

关 键 词：髋关节骨折 轻比重丁哌卡因 蛛网膜下腔麻醉 高龄 手术 剂量 阻滞效果 不良反应 

分 类 号：R614[医药卫生—麻醉学]