中国实用医药
中國實用醫藥
중국실용의약
CHINA PRACTICAL MEDICAL
2009年
18期
19-21
,共3页
脊髓麻醉%罗哌卡因%芬太尼%老年患者
脊髓痳醉%囉哌卡因%芬太尼%老年患者
척수마취%라고잡인%분태니%노년환자
Spinal anaesthesia%Ropivacaine%Fentanyl%Geriatric patients
目的 比较三种不同剂量罗哌卡因复合芬太尼在老年患者中脊髓麻醉临床效果,探求合理的用药剂量.方法 90例ASAⅠ～Ⅱ级、年龄60～80 岁、拟行下肢手术患者随机分为三组:Ⅰ组(0.5%重比重罗哌卡因4 mg +20 μg 芬太尼);Ⅱ组(0.5%重比重罗哌卡因5 mg + 20 μg芬太尼)和Ⅲ组(0.5%重比重罗哌卡因6 mg +20 μg芬太尼).L3～4穿刺成功后各组分别加入实验药物.记录感觉阻滞时间、感觉消退时间、运动阻滞程度和镇痛评分.结果 随着罗哌卡因剂量从4 mg增至6 mg,感觉平面上升至最高.4 ～5 mg时感觉阻滞平面明显增加(P＜0.05),但从5 mg增至6 mg则感觉平面阻滞无变化(P>0.05).达最大感觉阻滞平面时间Ⅱ组和Ⅲ组差异无统计学意义(P>0.05).同其他两组比较Ⅲ组患者感觉消退至S2时间最长(P>0.05).Ⅱ组和Ⅲ组镇痛效果明显好于Ⅰ组(P＜0.05).Ⅲ组术中低血压发生率高于Ⅰ、Ⅱ组.结论 在老年患者手术中用5 mg布比卡因+20 μg芬太尼脊髓麻醉可提供可靠和满意的感觉和运动阻滞.6 mg布比卡因也可提供满意的麻醉效果,但可引起明显的低血压.
目的 比較三種不同劑量囉哌卡因複閤芬太尼在老年患者中脊髓痳醉臨床效果,探求閤理的用藥劑量.方法 90例ASAⅠ～Ⅱ級、年齡60～80 歲、擬行下肢手術患者隨機分為三組:Ⅰ組(0.5%重比重囉哌卡因4 mg +20 μg 芬太尼);Ⅱ組(0.5%重比重囉哌卡因5 mg + 20 μg芬太尼)和Ⅲ組(0.5%重比重囉哌卡因6 mg +20 μg芬太尼).L3～4穿刺成功後各組分彆加入實驗藥物.記錄感覺阻滯時間、感覺消退時間、運動阻滯程度和鎮痛評分.結果 隨著囉哌卡因劑量從4 mg增至6 mg,感覺平麵上升至最高.4 ～5 mg時感覺阻滯平麵明顯增加(P＜0.05),但從5 mg增至6 mg則感覺平麵阻滯無變化(P>0.05).達最大感覺阻滯平麵時間Ⅱ組和Ⅲ組差異無統計學意義(P>0.05).同其他兩組比較Ⅲ組患者感覺消退至S2時間最長(P>0.05).Ⅱ組和Ⅲ組鎮痛效果明顯好于Ⅰ組(P＜0.05).Ⅲ組術中低血壓髮生率高于Ⅰ、Ⅱ組.結論 在老年患者手術中用5 mg佈比卡因+20 μg芬太尼脊髓痳醉可提供可靠和滿意的感覺和運動阻滯.6 mg佈比卡因也可提供滿意的痳醉效果,但可引起明顯的低血壓.
목적 비교삼충불동제량라고잡인복합분태니재노년환자중척수마취림상효과,탐구합리적용약제량.방법 90례ASAⅠ～Ⅱ급、년령60～80 세、의행하지수술환자수궤분위삼조:Ⅰ조(0.5%중비중라고잡인4 mg +20 μg 분태니);Ⅱ조(0.5%중비중라고잡인5 mg + 20 μg분태니)화Ⅲ조(0.5%중비중라고잡인6 mg +20 μg분태니).L3～4천자성공후각조분별가입실험약물.기록감각조체시간、감각소퇴시간、운동조체정도화진통평분.결과 수착라고잡인제량종4 mg증지6 mg,감각평면상승지최고.4 ～5 mg시감각조체평면명현증가(P＜0.05),단종5 mg증지6 mg칙감각평면조체무변화(P>0.05).체최대감각조체평면시간Ⅱ조화Ⅲ조차이무통계학의의(P>0.05).동기타량조비교Ⅲ조환자감각소퇴지S2시간최장(P>0.05).Ⅱ조화Ⅲ조진통효과명현호우Ⅰ조(P＜0.05).Ⅲ조술중저혈압발생솔고우Ⅰ、Ⅱ조.결론 재노년환자수술중용5 mg포비잡인+20 μg분태니척수마취가제공가고화만의적감각화운동조체.6 mg포비잡인야가제공만의적마취효과,단가인기명현적저혈압.
Objective To evaluate and compare the efficacy of three different intrathecal dosages of 0.5% hyperbaric ropivacaine added with 20 μg fentanyl in geriatric patients.Methods Ninety patients of either sex, aged more than 60 years and scheduled to undergo lower limb surgery under spinal anaesthesia were allocated to three groups: Group I (n=30), received 4 mg of 0.5% hyperbaric ropivacaine + 20 μg fentanyl;Group II (n=30), received 5 mg of 0.5% hyperbaric ropivacaine + 20 μg fentanyl and Group III (n=30), received 6 mg of 0.5% hyperbaric ropivacaine + 20 μg fentanyl. Level of sensory block, time to two-segment regression and regression to S2 dermatome, degree of motor block and degree of analgesia was observed. Incidence of pruritis, nausea, vomiting and respiratory distress was recorded. Results There was a significant increase in median sensory level when dose of intrathecal ropivacaine was increased from 4 mg to 5 mg (P＜0.05). Time to two-segment regression and regression to S2 dermatome was maximum in group III when compared to the other two groups (P＜ 0.05). The duration of motor block in all the three groups was comparable (P>0.05). Intraoperative analgesia, graded by patients, was significantly better in groups II and III as compared to group I (P＜0.05). Four patients in group II and ten patients in group III had clinically evident hypotension, while six each in group II & III had mild pruritis which was selflimiting. Conclusions 5 mg intrathecal ropivacaine with 20 μg fentanyl provides reliable and satisfactory sensory and motor blockade for hip surgery in elderly patients. The 6 mg dose of ropivacaine is associated with significant hypotension.
