CAJ | 학술논문

目的：研究小剂量0．75％罗哌卡因在高龄下肢手术患者中的应用，并与0．75％布比卡因作对比研究。方法择期高龄下肢手术患者40例，年龄70～93岁，ASAⅠ～Ⅲ级，随机分为罗哌卡因组和布比卡因组，每组20例。2组分别在蛛网膜下腔分次小剂量注入0．75％罗哌卡因10 mg或0．75％布比卡因10 mg，直至出现最高有效麻醉平面，比较2组患者痛觉阻滞程度、最高阻滞平面、运动阻滞程度（改良Bromage分级法，MBS），且记录麻醉前（T0）、麻醉平面达到有效麻醉平面时（T1）、切皮后2 h（T2）和术毕（T3）心率、平均动脉压的变化。结果2组患者均可达到完善的镇痛效果，但罗哌卡因组的镇痛起效时间、运动阻滞起效时间、最大运动阻滞时间均比布比卡因组显著延长（P＜0．05）；最高阻滞平面低于布比卡因组（P＜0．05）；而痛觉恢复时间、运动恢复时间较布比卡因组显著缩短（P＜0．05）；罗哌卡因组最大Bromage分级明显优于布比卡因组（P＜0．05）。结论小剂量0．75％罗哌卡因在连续腰麻中应用于高龄患者下肢手术，麻醉效果满意，而且能够达到较为完善的镇痛效果，肌肉松弛好，为高龄患者的手术麻醉提供了一种有效且安全可行的方法。
목적：연구소제량0．75％라고잡인재고령하지수술환자중적응용，병여0．75％포비잡인작대비연구。방법택기고령하지수술환자40례，년령70～93세，ASAⅠ～Ⅲ급，수궤분위라고잡인조화포비잡인조，매조20례。2조분별재주망막하강분차소제량주입0．75％라고잡인10 mg혹0．75％포비잡인10 mg，직지출현최고유효마취평면，비교2조환자통각조체정도、최고조체평면、운동조체정도（개량Bromage분급법，MBS），차기록마취전（T0）、마취평면체도유효마취평면시（T1）、절피후2 h（T2）화술필（T3）심솔、평균동맥압적변화。결과2조환자균가체도완선적진통효과，단라고잡인조적진통기효시간、운동조체기효시간、최대운동조체시간균비포비잡인조현저연장（P＜0．05）；최고조체평면저우포비잡인조（P＜0．05）；이통각회복시간、운동회복시간교포비잡인조현저축단（P＜0．05）；라고잡인조최대Bromage분급명현우우포비잡인조（P＜0．05）。결론소제량0．75％라고잡인재련속요마중응용우고령환자하지수술，마취효과만의，이차능구체도교위완선적진통효과，기육송이호，위고령환자적수술마취제공료일충유효차안전가행적방법。
Objective To investigate the clinical effects of 0.75%ropivacaine and 0.75%bupivacaine in continu-ous spinal anesthesia ( CSA) for lower limbs operation in elderly patients .Methods 40 cases of elderly patients ( aged 70-93 years, ASAⅠ-Ⅲ) were randomly devided into ropivacaine group (group R, n=20) and bupivacaine group (group B, n=20).The patients were injected with fractionated low dose of 10 mg 0.75%ropivacaine (group R) or 10 mg 0.75%bupivacaine ( group B) into the subarachnoid space at L 2-3 until the highest block level of effective anesthesia was reached .The degree of analgesia , highest pain blocking plane , and degrees of motor block ( modified Bromage scale , MBS) between the two groups were compared .The heart rate ( HR) and mean aterial pressure ( MAP) before anesthesia ( T0 ) , at the time when effective analgesic plane was reached ( T1 ) , 2 h after incision ( T2 ) , and at the end of operation (T3) were recorded.Results Satisfactory analgesic effect was observed in all the patients in the two groups .However, the time to onset of analgesia and motor block and the maximum motor block time in group R were considerably prolonged compared with group B (P<0.05).Compared with group B, group R had a lower highest pain blocking plane (P<0.05)and significanly shorter pain recovery time and motor recovery time (P<0.05).The time of pain and movement recovery was shorter in group R than in group B (P<0.05).The maximum MBS was much higher in group R compared with group B (P<0.05).Conclusions 0.75%low dose ropivacaine is safe and effective in CSA for lower limbs opera-tion in elderly patients , with better analgesic effect and muscle relaxation and less side effects and complications .It pro-vides an effective and safe way of anesthesia in operation for elderly patients .