超声引导下不同剂量罗哌卡因神经阻滞用于老年创伤性下肢骨折患者的麻醉效果  

Anesthesia Effect of Different Doses of Ropivacaine Nerve Block Guided by Ultrasound in Elderly Patients with Traumatic Lower Extremity Fractures

作　　者：吴照飞 邹卫琼 陈英 谭东霞 罗锋[1] WU Zhao-Fei;ZOU Wei-Qiong;CHEN Ying;TAN Dong-Xia;LUO Feng(Department of Anesthesiology,Hankou hospital,Wuhan 430012,China;Operating room of Hankou hospital,Wuhan 430012,China)

机构地区：[1]武汉市汉口医院麻醉科,武汉430012 [2]武汉市汉口医院手术室,武汉430012

出　　处：《中国药物经济学》2023年第4期51-54,共4页China Journal of Pharmaceutical Economics

摘　　要：目的探讨超声引导下不同剂量罗哌卡因神经阻滞用于老年创伤性下肢骨折患者的麻醉效果。方法选取2019年1月至2021年12月经武汉市汉口医院确诊并进行外科手术治疗的78例老年创伤性下肢骨折患者作为研究对象,采用随机抽签法分为A组、B组、C组,每组26例,且分别在超声引导下给予0.35%、0.30%、0.25%罗哌卡因神经阻滞。观察记录各组患者感觉阻滞、运动阻滞起效时间及持续时间、术后并发症发生情况以及不同时间点血流动力学指标、视觉模拟评分法(VAS)评分变化情况。结果C组感觉阻滞、运动阻滞起效时间均长于B组、A组(C组>B组>A组,P<0.05),持续时间短于B组、A组(C组<B组<A组,P<0.05)。手术切皮时(T1)、缝合切口时(T2)、进入麻醉苏醒室后30 min(T3)时C组动脉压(MAP)、心率(HR)水平均明显高于B组、A组(C组>B组>A组,P<0.05)。3组患者组内VAS评分随着时间的推移先升高后降低(P<0.05),但3组患者术后4 h、12 h、24 h、48 h的VAS评分比较差异无统计学意义(P>0.05)。C组患者术后并发症发生率明显低于A组、B组(3.85%vs.30.77%vs.23.08%,P<0.05)。结论超声引导下不同剂量罗哌卡因神经阻滞均能够满足老年创伤性下肢骨折患者的手术需求,但0.25%罗哌卡因的血流动力学稳定性优于0.35%、0.30%罗哌卡因,且安全性较更高。Objective To explore the anesthesia effect of different doses of ropivacaine nerve block guided by ultrasound in elderly patients with traumatic lower extremity fractures.Methods A total of 78 elderly patients with traumatic lower extremity fractures who were diagnosed in Hankou hospital from January 2019 to December 2021 and underwent surgical treatment were selected as the research subjects,and then the patients were divided into groups A,B and C by random drawing,26 cases in each group,and they were given 0.35%,0.30%,0.25%ropivacaine nerve block under ultrasound guidance,respectively.The onset time and duration of sensory block,motor block,postoperative complications,and changes in hemodynamic indexes and VAS scores at different time points were observed and recorded in each group.Results The onset times of sensory block and motor block in group C were longer than those in groups B and A(Group Cgroup Bgroup A,P<0.05),and the duration was shorter than group B and group A(group Cgroup Bgroup A,P<0.05).At T_1,T_2,and T_3,the levels of MAP and HR in group C were significantly higher than those in groups B and A(group Cgroup Bgroup A,P<0.05).The VAS scores of the three groups increased first and then decreased over time(P<0.05),but there was no significant difference in the VAS scores of the three groups at 4,12,24,and 48 hours after surgery(P<0.05).The incidence of postoperative complications in group C was significantly lower than that in groups A and B(3.85%vs.30.77%vs.23.08%,P<0.05).Conclusion Different doses of ropivacaine nerve block under ultrasound guidance can meet the surgical needs of elderly patients with traumatic lower extremity fractures,but the hemodynamic stability of 0.25%ropivacaine is better than that of 0.35%or 0.30%ropivacaine with higher safety.

关 键 词：罗哌卡因 神经阻滞 老年患者 创伤性下肢骨折 麻醉效果 

分 类 号：R683.42[医药卫生—骨科学] R971[医药卫生—外科学]