罗哌卡因腰麻联合硬膜外麻在老年患者中的临床应用
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[摘要] 目的：观察罗哌卡因用于老年腰麻-硬膜外联合麻醉的临床效果和不良反应，并与布比卡因进行比较。方法：选择96例行下腹、下肢手术的老年患者，随机分为两组：罗哌卡因(R)组48例和布比卡因(B)组48例，采用CSEA麻醉。术中监测患者血压、心率、氧饱和度、麻醉平面及下肢运动阻滞情况，并记录恶心、呕吐、头痛等不良反应。结果：两组麻醉平面﹑不良反应发生率差异无统计学意义，术中下肢运动阻滞，R组明显弱于B组且术后下肢运动阻滞消退快于B组(P<0.05)。结论：罗哌卡因与布比卡因用于老年患者CSEA皆能达到满意的麻醉和术后镇痛效果，罗哌卡因运动阻滞弱于布比卡因，更有利于患者术后早期下床活动及胃肠功能的恢复。
[关键词] 罗哌卡因；腰麻-硬膜外联合麻醉；老年患者
[中图分类号]R614.4+2 [文献标识码]B [文章编号]1673-7210(2009)02(b)-045-02
Clinical application of combined spinal-epidural anesthesia with Ropivacaine in the elders
DING Hong
(Department of Anesthesiology, the First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China)
[Abstract] Objective: To compare the anesthetic and analgesic efficacy of Ropivacaine, bupivacaine and their side reactions in combined spinal-epidural anesthesia and postoperative analgesia inthe elders. Methods: 96 elderly patients undergoing lower abdomen and limbs operation were randomly assigned to receive either Ropivacaine(Group R, n=48) or Bupivacaine(Group B, n=48)for CSEA. The observed variables were the changes in BP, HR, SpO2, block level, and motion block. recession of motor block, and the incidence of headache, nausea and vomiting, leg numbness within 24 h after operation. Results: There was no significant difference between two groups either in block level or in side reactions. Motor block was much milder in group R than that in group B, and recessed faster after operation(P<0.05). Conclusion: Either Ropivacaine or Bupivacaine can be used in CSEA for analgesia during and after operation in the elders. However, Ropivacaine has a milder motion block than bupivacaine, which benefits early ambulation after operation and recovery of gastrointestinal function.
[Key Words] Ropivocaine; Combined spinal-epidural anesthesia; The elders
罗哌卡因是一种新型长效酰胺类局麻药，近年来其在腰麻中得到广泛应用，但在老年患者的应用报道较少。2003年8月～2009年9月我们对96例老年下腹下肢手术患者应用罗哌卡因等比重液实施腰-硬膜外联合阻滞(CSEA)，并与用布比卡因麻醉进行比较。现报道如下：
1 资料与方法
1.1 一般资料
选择择期手术老年患者96例，男50例，女46例；年龄68～95岁，平均(78.5±11.2)岁；体重38～78 kg，平均(54.1±15.6) kg。手术种类：全髋关节置换13例，人工股骨头置换15例，股骨胫腓骨骨折25例，前列腺经尿道电切术10例，经尿道输尿管镜取石术10例，疝气修补术23例。ASA I～Ⅲ级。术前合并有高血压48例，冠心病25例，慢性支气管炎14例，糖尿病8例，脑梗死后遗症5例 ......
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