罗哌卡因连续腰麻在老年患者下肢手术的应用(1)
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[摘要]目的:评价罗哌卡因经Spinocath导管行连续腰麻(CSA)用于老年患者下肢手术的临床效果。方法:60例下肢手术的老年患者,年龄65～95岁,ASAⅠ～Ⅲ级,随机分为CSA组和腰麻硬膜外联合麻醉(CSEA)组,两组均选择L2~3间隙穿刺,CSA组负荷剂量为0.75%罗哌卡因0.5~1 ml,CSEA组注入0.75%罗哌卡因1.0~2.0 ml,CSEA组硬膜外向头端置管3~4 cm,CSA组蛛网膜下腔置入Spinocath导管1～2 cm,观察并记录两组麻醉前和麻醉后5、10、15、30 min、1 h及术毕的平均动脉压、心率和脉搏血氧饱和度,记录2组的麻醉效果及不良反应。结果:阻滞平面达T10时CSA组的局麻药用量(1.1 ml)明显少于CSEA组(1.7 ml)(P<0.05)。CSEA组阻滞平面达T10的时间(5.6 min)明显早于CSA组(10 min)(P<0.05),CSEA组达最高阻滞平面的时间和下肢运动完全阻滞的时间也明显早于CSA组(P<0.05)。CSA组自蛛网膜下腔用药后血压无明显下降,而CSEA组麻醉后5~30 min血压显著下降 (P<0.05),两组患者血压下降的最大幅度有明显差别(P<0.01)。CSA组麻黄素的用量显著少于CSEA组(P<0.01)。结论:罗哌卡因经Spinocath导管用于CSA,局麻药用量小,血流动力学稳定,可控性强,适用于老年下肢手术。
[关键词] 罗哌卡因; 连续腰麻; 下肢; 老年患者; 血流动力学
[中图分类号] R614.4[文献标识码] A[文章编号] 1671-7562(2010)04-0333-04
doi: 10.3969/j.issn.1671-7562.2010.04.002
Application of continuous spinal anesthesia with ropivacaine for elderly
patients undergoing lower limb surgery
ZENG Zhenping, YU Wanbo
(Department of Anesthesiology, Peoples Hospital of Meizhou, Meizhou 514031,China)
[Abstract]Objective: To compare the anesthesic effect and hemodynamic changes between the continuous spinal anesthesia(CSA) and combined spinalepidural anesthesia (CSEA) with ropivacaine in patients for lower limb surgery. Methods: Sixty ASA classⅠⅢ patients aged 68 to 101 years, undergoing extremities operation were randomly divided into CSA group and CSEA group. Spinal anesthesia was performed at L23 interspace. An initial subarachnoid bolus of 0.75% hyperbaric ropivacaine 0.51 ml was injected in the CSA group, if analgesia did not reach T10, supplemental ropivacaine was injected by titrate incremental doses. In the CSEA group, 0.75% hyperbaric ropivacaine 12 ml was injected to the subarachnoid at L2-3, and then a catheter was inserted into the epidual space for anesthesia mainteinance. The levels and times of sensory and motor block and hemodynamic changes were measured and analysed ......
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