小剂量布比卡因腰麻对老年心力衰竭患者围术期心功能的影响  

Effects of low-dose bupivacaine lumbar anesthesia on the heart function of elderly patients with heart failure at perioperative period

作　　者：刘飞飞[1] 刘欣[1] 石娜[1] 赵爽[1] 李昭[1] 吴川[1] 王秀丽[1] LIU Feifei;LIU Xin;SHI Na(Department of Anesthesiology,The Third Hospital of Hebei Medical Univesity,Hebei,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院麻醉科,石家庄市050051

出　　处：《河北医药》2020年第21期3269-3271,3275,共4页Hebei Medical Journal

基　　金：河北省政府资助临床优秀人才培养和基础课题研究项目。

摘　　要：目的观察小剂量布比卡因腰麻对老年心力衰竭患者围术期心功能的影响。方法纳入2018年1月至2020年1月就诊行髋部手术的老年心力衰竭患者90例,年龄75~92岁,体重53~82 kg,NYHA分级Ⅱ~Ⅲ级,左心室EF 40%~49%,B型利钠肽(BNP)800~1800 pg/ml。患者采用随机数字表法随机分为A组、B组和C组,每组30例。3组行蛛网膜下腔穿刺成功后分别注入不同剂量的布比卡因:0.25%2 ml布比卡因组(A组)、0.33%2 ml布比卡因组(B组)和0.40%2 ml布比卡因组(C组)。记录患者入室后(T1)、腰麻药注入后15 min(T2)、手术开始10 min(T3)、手术结束(T4)不同时点的心率(HR)、平均动脉压(MAP);记录麻醉起效时间、平面维持时间、手术时间、舒芬太尼用量、不良反应发生率。记录患者术后24 h的BNP、左心室射血分数(LVEF)并与术前比较。结果3组各时点HR和MAP比较差异无统计学意义(P>0.05)。与A组比较,B组感觉阻滞起效时间缩短,麻醉维持时间延长,切皮时体动反应发生率小,舒芬太尼用量少,麻醉效果满意(P<0.05)。与C组比较,B组不良反应发生少,低血压发生率降低,去甲肾上腺素用量少(P<0.05)。3组的BNP和LVEF组间、组内比较差异均无统计学意义(P>0.05)。结论小剂量布比卡(0.33%,2 ml)因腰麻在老年心力衰竭患者髋部手术中血流动力学稳定,效果安全确切,对心功能影响轻微。Objective To investigate the effects of low-dose bupivacaine lumbar anesthesia on the heart function of elderly patients with heart failure(HF)at perioperative period.Methods Ninety elderly patients with HF(NYHA classificationⅡ~Ⅲ),who underwent hip surgery in our hospital from January 2018 to January 2020,with age range being 75~92yr,body weight 53~82kg,left ventricular EF 40%~49%,BNP 800~1,800pg/ml,were enrolled in the study,who were randomly divided into group A,group B and group C,with 30 cases in each group.The patients in group A were given 0.25%bupivacaine 2ml by subarachnoid injection,and the patients in group B were given 0.33%bupivacaine 2ml,and the patients in group C were given 0.40%bupivacaine 2ml.The MAP and HR were recorded before induction of anesthesia(T1),at 15min after spinal anesthesia(T2),at 30min after operation(T3),at the end of operation(T4)and 24h after surgery.Moreover the onset time of anesthesia,maintenance time of plane,operation time,sufentanil dosage,incidence of adverse reactions were recorded.In addition the levels of BNP and LVEF at 24h after surgery were observed and compare with those before operation.Results There were no significant differences in the levels of MAP and HR in different time points among the three groups(P>0.05).As compared with that in group A,the onset time of sensory block in group B was shortened,and the anesthesia maintenance time was prolonged,the incidence of body movements during skin incision was decreased,the amount of sufentanil was smaller,and the anesthetic effects were satisfactory(P<0.05).as compared with that in group C,the incidence rate of adverse reactions in group B group was decreased,the incidence of hypotension was reduced,and the amount of norepinephrine was less(P<0.05).However there were no significant differences in the levels of BNP and LVEF among the three groups(P>0.05).Conclusion The low-dose bupivacaine umbar anesthesia(0.33%,2ml)has the advantages of stable hemodynamics during hip surgery in elderly patients with HF,with defi

关 键 词：老年人 心力衰竭 髋部手术 麻醉 

分 类 号：R971.2[医药卫生—药品]