小剂量轻比重罗哌卡因腰硬联合阻滞用于老年下肢手术临床观察.docVIP

小剂量轻比重罗哌卡因腰硬联合阻滞用于老年下肢手术临床观察 　　【摘要】 目的 观察小剂量轻比重罗哌卡因腰-硬联合阻滞在老年人下肢手术的麻醉效果和安全性。方法 60例单侧下肢手术老年病人,ASAⅡ～Ⅲ级,随机分为R1(0.5%罗哌卡因10 mg)、R2(0.4%罗哌卡因8 mg)、R3(0.3%罗哌卡因5～7 mg)3组,取患肢上方侧卧位L3-4间隙穿刺,蛛网膜下腔注药。观察麻醉效果、麻醉后血流动力学变化、麻醉不良反应。结果 3组均成功单侧阻滞,镇痛效果满意。感觉阻滞起效时间、感觉阻滞最大平面差异无统计学意义;感觉阻滞消退时间R2、R3组明显短于R1组(P0.01),R2、R3两组肌松弱于R1组但不影响手术进行。血压下降幅度R3组显著小于R1组(P0.01)。结论 小剂量(5～7 mg)轻比重罗哌卡因腰-硬联合单侧阻滞更适用于老年下肢手术麻醉。 　　【关键词】 罗哌卡因;小剂量;轻比重;腰-硬联合阻滞;老年人;下肢手术 　　【Abstract】 Objective To observe the clinical efficacy and safety of combined spinal-epidural anesthesia with light specific gravity of low dose ropivacaine in the aged patients undergoing lower limb surgery.Methods Sixty aged patients with unilateral lower extremity surgery,ASA II～III,were randomly divided into three groups:group R1(0.5% ropivacaine 10 mg),group R2(0.4% ropivacaine 8 mg) and group R3(0.3% ropivacaine 5～7 mg).The anesthetic efficacy,hemodynamic changes and side effects were observed.Results Each group produced perfect quality of anesthesia.The blockade of single leg occurred in all patients.There was no significant difference in onset time and maximum level of sensory block among the three groups.Regression time of sensory block in group R2 and R3 were less than those in group R1(P0.01).The effect of muscle relaxation of the groups R3 was inferior to that of the group R1and the safety were not affected.The reduction of BP ofgroup R3 were less than that of the group R1(P0.01).Conclusion Combined spinal-epidural anesthesia with light specific gravity of low dose ropivacaine(5～7 mg)is suitable for aged patients undergoing lower limb surgery. 　　【Key words】 Ropivacaine;Low dose;Light specific gravity;Combined spinal-epidural anesthesia;Aged;Lower limb surgery 　　 　　老年人麻醉耐受性差,选择合理的麻醉方式和药物尤为重要。腰-硬联合阻滞由于技术的改进在临床上得以广泛应用。罗哌卡因是一种新型长效酰胺类局麻药,毒性小,具有独特的感觉-运动阻滞分离特点,我们将小剂量轻比重罗哌卡因腰-硬联合阻滞用于老年下肢手术,取得了较好效果,报告如下。 　　1资料与方法 　　1.1一般资料选择择期或急症下肢手术老年病人60例,男38例,女22例;年龄68～97岁;体重35～71 kg,ASAⅡ～Ⅲ级,所有病人均存在不同情况并发症。手术类型:全髋关节置换3例,人工股骨头置换15例,各类下肢骨折复位内固定37例,下肢截肢(趾)5例。随机分为