丁哌卡因小剂量轻比重腰―硬联合麻醉在高龄患者下肢手术中的安全性探讨.docVIP

丁哌卡因小剂量轻比重腰―硬联合麻醉在高龄患者下肢手术中的安全性探讨 　　[摘要] 目的 探讨高龄患者下肢手术中采用丁哌卡因小剂量轻比重单侧蛛网膜下腔阻滞联合硬膜外麻醉的安全性。 方法 选取2013年2月～2015年2月我院就诊的高龄股骨头坏死患者75例，所有患者随机分为硬膜外组37例与腰-硬联合麻醉组38例。观察两组患者的麻醉效果，局麻药用量、痛觉恢复时间、麻醉起效时间和持续时间，Bromage等级评分及不良反应发生率。 结果 腰-硬联合麻醉组的优良率为97.37%，明显高于硬膜外组的89.19%，两组比较差异有统计学意义（P0.05）。腰-硬联合麻醉组患者的局麻药用量、痛觉恢复时间、麻醉起效时间和持续时间均明显低于硬膜外组，两组比较差异有统计学意义（P0.05）。两组患者Bromage等级评分显示，腰-硬联合麻醉组的麻醉效果明显优于硬膜外组，两组比较差异有统计学意义（P0.05）。腰-硬联合麻醉组的不良反应率为13.16%，硬膜外组为35.14%，两组比较差异有统计学意义（P0.05）。 结论 丁哌卡因小剂量轻比重单侧蛛网膜下腔阻滞联合硬膜外麻醉用于高龄患者下肢手术麻醉效果确切，可以明显降低不良反应发生率，值得临床推广应用。 　　[关键词] 单侧蛛网膜下腔阻滞；硬膜外麻醉；小剂量；轻比重；高龄患者；下肢手术；安全性 　　[中图分类号] R614 [文献标识码] B [文章编号] 2095-0616（2015）20-71-04 　　Study on safety of small dose of hypobaric bupivacaine combined spinal epidural anesthesia in elderly patients with lower limb surgery 　　ZHANG Chengyang 　　Department of Anesthesiology，the Peoples Hospital of Lianshui，Lianshui 223400 　　[Abstract] Objective To explore the safety of small dose of hypobaric bupivacaine unilateral subarachnoid block combined with epidural anesthesia in elderly patients with lower limb surgery. Methods 75 patients with senile femoral head necrosis from February 2013 to February 2015 were randomly divided into epidural group of 38 cases and combined spinal epidural anesthesia group of 37 cases.The anesthesia effect，dosage of local anesthetic and pain recovery time，onset time and duration of anesthesia and Bromage grade score and adverse reaction incidence of patients of the two groups were observed and compared. Results The fine rate of combined spinal epidural anesthesia group was 97.37%，significantly higher than 89.19% in the epidural group，the difference was significant between the two groups（P 　　[Key words] Unilateral subarachnoid block；Epidural anesthesia；Small dose；Light weight；Elderly patients；Lower extremity surgery；Safety 　　老年患者麻醉一直是临床麻醉中关注的热点，老年下肢手术患者围术期并发症的发生率和死亡率明显增加。手术由于要求神经阻滞范围达到T10 ～ S5，硬膜外麻醉所需局麻药用量较大，还常常存在会阴部阻滞不全的情况[1-2]。老年患者并发症多，大部分有不同程度的心肺功能不全，心血管调节功能较差，椎管内麻醉特别是脊麻容易发生严重的心肌抑制及血流动力学改变，使麻醉医生在使用脊麻用于老年患