小剂量罗哌卡因复合氢吗啡酮在老年髋关节置换术中的临床观察  

Observation of low⁃dose ropivacaine combined with hydromorphone in elderly patients undergoing hip replacement surgery

作　　者：马建 李琳 岳定雄 张凯 胡泽凡 刘宏 MA Jian;LI Lin;YUE Dingxiong;ZHANG Kai;HU Zefan;LIU Hong(Department of Anesthesiology,Xiaogan First People's Hospital,Xiaogan 432100,China)

机构地区：[1]孝感市第一人民医院麻醉科,湖北孝感432100

出　　处：《麻醉安全与质控》2025年第1期28-31,共4页Perioperative Safety and Quality Assurance

摘　　要：目的探讨小剂量低浓度罗哌卡因复合氢吗啡酮在老年髋关节置换术中的有效性和安全性。方法选取2023年1~12月在孝感市第一人民医院行髋关节置换术的老年患者90例,年龄60~85岁,体质量50~85 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法将患者分为两组:罗哌卡因组(A组,n=44)、罗哌卡因+氢吗啡酮(B组,n=46),A组给予罗哌卡因12 mg,B组给予罗哌卡因7 mg+氢吗啡酮100μg,均用脑脊液稀释配成2.0 mL。比较两组患者的一般情况,观察并记录麻醉后15 min麻醉平面(采用针刺法),麻醉前(M_(1))、麻醉后1 min(M_(2))、麻醉后5 min(M_(3))、麻醉后10 min(M_(4))、麻醉后15 min(M_(5))平均动脉压(MAP)和心率(HR)的变化,手术结束后运动神经恢复情况(采用Bromage运动评分)以及低血压、恶心呕吐、尿潴留、会阴瘙痒、呼吸抑制等不良反应的发生情况。结果两组患者麻醉平面的比较,A组与B组麻醉平面均在T_(10)以上,符合手术需求,但达到T_(8)、T_(9)麻醉平面A组明显高于B组,差异有统计学意义(P<0.05);麻醉前MAP及HR差异无统计学意义(P>0.05),M_(2)、M_(3)、M_(4)、M、M_(5)时点MAP及HR比较,A组低于B组,差异有统计学意义(P<0.05);手术结束后B组Bromage运动评分明显低于A组,无运动神经阻滞B组明显高于A组,差异有统计学意义(P<0.05);在不良反应上,A组低血压、尿潴留发生率明显高于B组,B组会阴瘙痒发生率高于A组,差异有统计学意义(P<0.05)。结论小剂量低浓度罗哌卡因复合氢吗啡酮在老年髋关节置换中镇痛效果好,血流动力学稳定,运动神经恢复快,麻醉不良反应发生率低。Objective To investigate the efficacy and safety of low⁃dose ropivacaine combined with hydromorphone in elderly patients undergoing hip replacement surgery.Methods Ninety elderly patients aged 60-85 years,weighting 50-85 kg,ASAⅡorⅢ,who underwent hip replacement surgery at Xiaogan First People's Hospital from January to December 2023,were selected.The patients were randomly divided into two groups according to random number table method:ropivacaine group(group A,n=44),ropivacaine+hydro⁃morphone group(group B,n=46).Group A was given ropivacaine 12 mg,and group B was given ropivacaine 7mg+hydromorphone 100μg,which was mixed with the cerebrospinal fluid and diluted to 2 mL.The general conditions of the patients in both groups were com⁃pared.The changes of the mean arterial pressure(MAP)and heart rate(HR)before anesthesia(M_(1)),1 minute after anesthesia(M_(2)),5 minutes after anesthesia(M_(3)),10 minutes after anesthesia(M_(4)),and 15 minutes after anesthesia(M_(5))were observed and recorded.The recovery of motor nerves after surgery(using Bromage exercise score),the occurrence of hypotension,nausea and vomiting,urinary retention,perineal pruritus,respiratory depression and other adverse reactions were observed and recorded.Results The comparison of anesthesia levels between the two groups of patients showed that both group A and group B had anesthesia levels above T_(10) level of spinal nerve,which met the surgical requirements.However,there were more patients whose anesthesia level reached T_(8) and T_(9) level of spinal nerve in group A than those in group B,and the difference was statistically significant(P<0.05);there was no statistically significant difference in MAP and HR before anesthesia(P>0.05),while the comparison of MAP and HR at M_(2),M_(3),M_(4),M_(5),showed that group A was lower than group B,and the difference was statistically significant(P<0.05);after the surgery,Bromage motor scores of group B were lower than those of group A,and the difference was statistically significant(P<0.05);in t

关 键 词：盐酸罗哌卡因 盐酸氢吗啡酮 老年髋关节置换术 有效性和安全性 

分 类 号：R61[医药卫生—外科学]