摘要
目的观察蛛网膜下腔阻滞时加用小剂量舒芬太尼对老年髋部骨折患者瞳孔直径及意识的影响。方法采取随机、对照、双盲的方法选取2016年3至2017年12月于北京积水潭医院创伤骨科就诊的70例年龄≥65岁行股骨粗隆间骨折复位固定手术患者为研究对象,按照随机数字法分为观察组和对照组,每组35例。所有患者均接受蛛网膜下腔阻滞麻醉,使用25G腰麻针于L3～4间隙穿刺进行单次蛛网膜下腔注射,给药方向朝向头侧。观察组患者蛛网膜下腔给予含有舒芬太尼5μg的0. 4%罗哌卡因2. 5 m L;对照组给予0. 4%罗哌卡因2. 5 m L。于穿刺前3 min、注药后3、5、30、60、90、120 min记录两组患者感觉阻滞平面、瞳孔直径、观察者警觉/镇静评分法(OAA/S)镇静评级、Ramsay镇静评分和脑电双频指数(BIS)值,观察并记录并发症发生情况。结果观察组患者注药后3～90 min瞳孔直径缩小(P <0. 01),对照组瞳孔直径在各时间点均无明显变化(P> 0. 05)。观察组患者注药后30及60 min Ramsay镇静评分高于对照组(P <0. 01),各组患者不同时间点OAA/S镇静评级及BIS值均无明显变化(P> 0. 05)。观察组低血压发生率均低于对照组[2. 9%(1/35)比25. 7%(9/35)](P <0. 05),瘙痒发生率高于对照组[68. 6%(24/35)比0%(0/35)](P <0. 05)。结论舒芬太尼混合罗哌卡因行蛛网膜下腔阻滞可引起老年髋部手术患者瞳孔缩小及Ramsay镇静评分升高,而对OAA/S镇静评级及BIS值没有影响,并会引起短时间的瘙痒,但血流动力学更加稳定。
Objective To observe the effect of subarachnoid block combined with small dose of sufentanil on pupil diameter and consciousness in elderly patients with hip fracture.Methods This study adopted a randomized,controlled,double-blind method.70patients(age≥65years)undergoing intertrochanteric fracture reduction and fixation surgery in department of Orthopedic Trauma,Beijing Jishuitan Hospital from Mar.2016to Dec.2017were enrolled in this study.The patients were divided into an observation group and a control group according to the random number method,35cases each.All patients received subarachnoid space block anesthesia,and a single subarachnoid space injection was performed using a 25G lumbar needle,the puncture site was located in L3-4intervertebral space with the administration direction toward the cephalad.In the observation group,2.5mL of0.4%ropivacaine containing sufentanil5μg was administered to the subarachnoid space;in the control group,2.5mL of0.4%ropivacaine was administered.The level of sensory block,pupil diameter,the observer′s assessment of alertness/sedation(OAA/S)scale,Ramsay sedation score,and bispectral index(BIS)value were recorded at3min before puncture and3,5,30,60,90and120min after injection,and the occurrence of complications was observed and recorded.Results In the observation group,the diameter of the pupil was reduced at3-90min(P<0.01).The pupil diameter of the patients in the control group had no significant changes at all time points(P>0.05).Ramsay sedation scores increased in the observation group were higher than those of the control group at30,60min after injection(P<0.01).OAA/S sedation rating scores and BIS values had no significant changes at all time points in both groups(P>0.05).The incidence of hypotension in the observation group was lower than that in the control group[2.9%(1/35)vs25.7%(9/35)](P<0.05),and the pruritus rate was higher than that in the control group[68.6%(24/35)vs0%(0/35)](P<0.05).Conclusion Sufentanil mixed ropivacaine used in subarachnoid block can cause
作者
种皓
周雁
郑少强
王妍
卢山
郗扬
张文超
王庚
杨明辉
CHONG Hao;ZHOU Yan;ZHENG Shaoqiang;WANG Yan;LU Shan;XI Yang;ZHANG Wenchao;WANG Geng;YANG Minghui(Department of Anesthesiology,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Clinical Laboratory,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Traumatic Orthopedics,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Anesthesiology,People′s Hospital of Changji Hui Autonomous Prefecture of Xinjiang Uygur Autonomous Region,Changji 831100,China)
出处
《医学综述》
2018年第23期4593-4599,共7页
Medical Recapitulate
基金
北京市科技计划(Z161100000516132)
关键词
髋部骨折
老年
舒芬太尼
罗哌卡因
麻醉
椎管内
瞳孔
镇静
Hip fracture
Elderly
Sufentanil
Ropivacaine
Anesthesia
Intraspinal
Pupil
Sedation
