小剂量轻比重布比卡因腰椎麻醉用于老年患者髋部手术的安全性研究  

Safety research of low-dose hypobaric bupivacaine for spinal anesthesia for hip surgery in elderly patients

作　　者：王春晓 李志华[1] 徐贯杰[1] 张秀宁[1] 郄晓娟[1] 郝立净[1] WANG Chun-xiao;LI Zhi-hua;XU Guan-jie;ZHANG Xiu-ning;QIE Xiao-juan;HAO Li-jing(Department of Anesthesiology,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院麻醉科,河北石家庄050051

出　　处：《河北医科大学学报》2022年第9期1079-1084,共6页Journal of Hebei Medical University

基　　金：政府资助临床医学优秀人才培养项目计划(20170415)。

摘　　要：目的比较不同剂量轻比重布比卡因腰椎麻醉用于老年患者髋部手术的安全性和有效性,以筛选出临床最佳安全剂量。方法选取择期行髋部手术的老年患者60例,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅱ~Ⅲ级。按照随机数字表法分为小剂量组(L组)、中剂量组(M组)和大剂量组(H组),每组20例。取患侧在上侧卧位,于L椎间隙行蛛网膜下腔阻滞麻醉,穿刺成功后于蛛网膜下腔注射0.375%布比卡因(0.75%布比卡因+无菌注射用水),按照单位身高0.033mg/cm、0.05 mg/cm、0.08 mg/cm分别计算出剂量。记录并比较3组患者入室(T)及给药后各时点(T~T)平均动脉压(mean arterial pressure,MAP)及心率(heart rate,HR)的变化;术中血管活性药使用情况;记录麻醉起效时间、麻醉平面固定时间、患侧麻醉阻滞节段数、麻醉阻滞持续时间;术中、术后各项并发症发生情况。结果H组血管活性药使用频次高于L组和M组,差异有统计学意义(P<0.05)。注药后3组MAP均呈先降低后升高趋势,H组MAP和HR波动幅度最大,组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。H组麻醉起效时间、麻醉平面固定时间短于L组和M组,且M组短于L组(P<0.05);麻醉镇痛持续时间长于L组和M组(P<0.05);术后1 d H组的Bromage评分高于L组和M组(P<0.05);3组MMSE评分均呈先降低后升高趋势,H组波动幅度最大,组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。H组术中低血压、窦性心动过缓发生率高于L组和M组,差异有统计学意义(P<0.05)。结论0.033 mg/cm小剂量布比卡因轻比重腰椎麻醉可安全有效地应用于老年患者髋部手术,为临床安全推荐剂量。Objective To compare the safety and effectiveness of different doses of hypobaric bupivacaine for spinal anesthesia for hip surgery in elderly patients, in order to screen the best clinical safety dose. Methods Sixty elderly patients with hip fracture of American Society of Anesthesiologists(ASA) Ⅱ-Ⅲ were scheduled for elective hip surgery. According to the random number table method, the patients were divided into low dose group(group L),medium dose group(group M) and high dose group(group H), with 20 cases in each group. The affected side was kept in the upper lateral supine position, and subarachnoid block anesthesia was performed in the Lin tervertebral space. After successful puncture, 0.375% bupivacaine(0.75% bupivacaine + sterilized water for injection) was injected into the subarachnoid space, and the doses were calculated according to unit height of 0.033 mg/cm,0.05 mg/cm, and 0.08 mg/cm, respectively. Changes of mean arterial pressure(MAP) and heart rate(HR) at entry(T) and at each time point(T-T) after administration in the three groups were recorded. Intraoperative use of vasoactive drugs, the onset time of anesthesia, fixation time of the anesthesia plane, the number of anesthesia block segments on the affected side, and the duration of anesthesia block, and the occurrence of complications during and after operation were recorded and compared among the three groups. Results The frequency of vasoactive drugs in group H was higher than that in groups L and M, and the difference was statistically significant(P<0.05). After injection, MAP in the three groups showed a trend of initial decrease and subsequent increase, with the greatest fluctuation in MAP and HR in group H, and there were statistically significant differences in the interaction among groups, time points, and time points among groups(P<0.05). The onset time of anesthesia and the fixation time of anesthesia plane in group H were shorter than those in groups L and M,and shorter in group M than in group L(P<0.05);The duration of anesthesia

关 键 词：髋骨折 麻醉 脊椎 布比卡因 老年人 80以上 

分 类 号：R681.6[医药卫生—骨科学] R614.41[医药卫生—外科学]