等效剂量罗哌卡因和布比卡因蛛网膜下腔阻滞在高龄髋部骨折患者术中的应用效果  

Application of equivalent dose ropivacaine and bupivacaine for subarachnoid block anesthesia in elderly patient undergoing hip fracture surgery

作　　者：于绍勇 周燕 李波 张世民 YU Shaoyong;ZHOU Yan;LI Bo;ZHANG Shimin(Department of Anesthesiology,Yangpu Hospital Affiliated to Tongji University,Shanghai,200090,China;Department of Orthopaedics,Yangpu Hospital Affiliated to Tongji University,Shanghai,200090,China)

机构地区：[1]同济大学附属杨浦医院麻醉科,上海200090 [2]同济大学附属杨浦医院骨科,上海200090

出　　处：《当代医学》2025年第1期43-46,共4页Contemporary Medicine

摘　　要：目的比较等效剂量罗哌卡因和布比卡因蛛网膜下腔阻滞在高龄髋部骨折术中的应用效果。方法选取2021年10月至2022年10月同济大学附属杨浦医院收治的120例老年髋部骨折患者作为研究对象,随机分为罗哌卡因组(L组)与布比卡因(B组),每组60例。两组均采用蛛网膜下腔阻滞麻醉,L组蛛网膜下腔穿刺成功后给予0.5%罗哌卡因2.4 ml,B组给予0.33%布比卡因2.4 ml,比较两组麻醉效果、术中生命体征[心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、动脉血二氧化碳分压(partial pressure of carbon dioxide in arterial blood,PaCO 2)]波动情况及不良反应发生情况。结果L组和B组的感觉最高阻滞平面分别为T 11、T 9;L组麻醉镇痛起效时间长于B组,镇痛持续时间及运动恢复时间均短于B组,差异有统计学意义(P<0.05)。T2、T3,L组HR均快于B组,MAP高于B组,差异有统计学意义(P<0.05)。术毕,B组PaCO 2高于术前,L组PaCO 2低于B组,差异有统计学意义(P<0.05)。两组未出现严重心律异常和术后腰痛等严重不良反应;L组不良反应发生率低于B组,追用麻黄碱发生率低于B组,差异有统计学意义(P<0.05)。结论与布比卡因相比,在高龄髋部骨折术中等效剂量的罗哌卡因对循环呼吸系统影响较小,术后不良反应发生率较低,罗哌卡因蛛网膜下腔阻滞麻醉在高龄髋部骨折手术中更有利于维持生命体征平稳,安全性较高。Objective To compare the effects of equivalent doses of ropivacaine and bupivacaine for subarachnoid block anesthesia in elderly patient undergoing hip fracture surgery.Methods A total of 120 elderly patients with hip fractures admitted to Yangpu Hospital Affiliated to Tongji University from October 2021 to October 2022 were selected as the research subjects,and they were randomly divided into the ropivacaine group(group L)and the bupivacaine group(group B),with 60 cases in each group.Both groups underwent subarachnoid block anesthesia,after successful spinal puncture,the group L received 2.4 ml 0.5%ropivacaine,while the group B received 2.4 ml 0.33%bupivacaine.The anesthetic effects,intraoperative vital sign fluctuations(heart rate[HR],mean arterial pressure[MAP],partial pressure of carbon dioxide in arterial blood[PaCO 2])and incidence of adverse reactions were compared between the two groups.Results The highest sensory block levels in the group L and group B were T 11 and T 9,respectively;the onset time of anesthesia and analgesia in the group L was longer than that in the group B,and the duration of analgesia and exercise recovery time were shorter than those in the group B,the differences were statistically significant(P<0.05).At T2 and T3,HR in the group L was faster than that in the group B,and MAP was higher than that in the group B,the differences were statistically significant(P<0.05).After operation,PaCO 2 in the group B was higher than before operation,and PaCO 2 in the group L was lower than that in the group B,the differences were statistically significant(P<0.05).No serious adverse reactions such as abnormal heart rhythm and postoperative low back pain were found in the two groups.The incidence of adverse reactions in the group L was lower than that in the group B,and the incidence of ephedrine supplementation was lower than that in the group B,the differences were statistically significant(P<0.05).Conclusion Compared with bupivacaine,an equivalent dose of ropivacaine for subarachnoid block in elde

关 键 词：罗哌卡因 布比卡因 蛛网膜下腔阻滞 高龄髋部骨折 

分 类 号：R614[医药卫生—麻醉学]