摘要
目的:探讨0.5%罗哌卡因轻比重腰-硬联合麻醉(CSEA)在有较严重合并症高龄患者侧卧位髋关节置换术中的应用安全性。方法:选择在CSEA下行髋关节置换手术的高龄患者80例,随机分为罗哌卡因组(R)和布比卡因组(B),均取患肢在上侧卧位,针内针法L2-L3穿刺,R组注入0.5%罗哌卡因6mg,B组注入0.5%布比卡因6mg,硬膜外腔头侧置管3cm。结果:R组感觉和运动阻滞起效时间、达最高阻滞平面时间均比B组长,但镇痛持续时间、最大Bromage评分持续时间比B组短(P<0.05);R组收缩压、舒张压、心率、脉搏血氧饱和度比B组更平稳,不良反应比B组少;血清肾素、血管紧张素Ⅱ、醛固酮浓度B组下降较R组明显。结论:0.5%罗哌卡因轻比重单侧腰麻-硬膜外联合阻滞应用于合并心肺功能不全、高黏血症等高龄患者侧卧位髋关节置换术安全有效。
Objective：To investigate the application safety and effect of combined spinal-epidural anesthesia （CSEA） with 0.5% hypobaric ropivacaine for the elderly with serious complications undergoing lateral position of hip replacement. Methods：Eighty elderly patients scheduled for lateral position of hip replacement with CSEA were randomly divided into group R and group B,which were anaesthetized by ropivacaine and bupivacaine respectively. Results：Onset time and time to maximal level of sensory block and motor block were longer in group R than those in group B respectively,while duration time of analgesia and maximal Bromage score in group R were shorter （all P0.05）. Compared with those in group B,systolic blood pressure （SBP）,diastolic blood pressure （DBP）,heart rate （HR） and pulse oxygen saturation （SpO2） were more stable and side effects were less in group R （all P0.05）. The concentrations of plasma rennin activity （PRA）,angiotensin Ⅱ（ATⅡ） and aldosterone （ALD） in group R were higher than those in group B respectively （all P0.05）. Conclusion：Unilateral CSEA with 0.5% hypobaric ropivacaine is safe and effective for the elderly with cardiopulmonary function incompetence and blood hyperviscosity undergoing hip replacement.
出处
《武汉大学学报（医学版）》
CAS
北大核心
2009年第6期810-813,共4页
Medical Journal of Wuhan University
关键词
罗哌卡因
腰-硬联合麻醉
老年人
髋关节手术
侧卧位
Ropivacaine
Combined Spinal-Epidural Anesthesia
Elderly
Hip Replacement
Lateral Position
