中国实用医药
中國實用醫藥
중국실용의약
China Practical Medical
2015年
33期
1-2,3
,共3页
腰硬联合麻醉%重比重%轻比重%罗哌卡因%老年患者%髋关节手术
腰硬聯閤痳醉%重比重%輕比重%囉哌卡因%老年患者%髖關節手術
요경연합마취%중비중%경비중%라고잡인%노년환자%관관절수술
Combined spinal epidural anesthesia%Hyperbaric%Hypobaric%Ropivacaine%Senile patients%Hip joint surgery
目的：比较重比重与轻比重盐酸罗哌卡因注射液单侧腰硬联合麻醉(CSEA)用于老年髋关节手术中的效果及其安全性。方法60例 ASA Ⅱ~Ⅲ级、择期行髋关节置换手术的老年患者，随机分为 A 组(轻比重腰麻组)和 B 组(重比重腰麻组)，每组30例。观察记录两组麻醉效果，麻醉期间收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO2)的数值，麻醉起效时间，阻滞完善时间，麻醉合并症及不良反应，用 Bromage 法评定运动神经阻滞情况。结果所有患者麻醉效果满意。两组组间和组内血流动力学及组间麻醉起效时间、阻滞完善时间及麻醉合并症、不良反应发生率比较差异均无统计学意义(P>0.05)。术毕 A 组 Bromage 评分分级明显低于 B 组，差异有统计学意义(P<0.01)。结论两种比重的盐酸罗哌卡因注射液单侧腰硬联合阻滞方法均可安全有效地用于老年髋关节手术患者，而轻比重 CSEA 术毕对老年患者运动神经阻滞较轻，术后双下肢保持了良好的运动功能，有利于患者术后早日康复。
目的：比較重比重與輕比重鹽痠囉哌卡因註射液單側腰硬聯閤痳醉(CSEA)用于老年髖關節手術中的效果及其安全性。方法60例 ASA Ⅱ~Ⅲ級、擇期行髖關節置換手術的老年患者，隨機分為 A 組(輕比重腰痳組)和 B 組(重比重腰痳組)，每組30例。觀察記錄兩組痳醉效果，痳醉期間收縮壓(SBP)、舒張壓(DBP)、心率(HR)、血氧飽和度(SpO2)的數值，痳醉起效時間，阻滯完善時間，痳醉閤併癥及不良反應，用 Bromage 法評定運動神經阻滯情況。結果所有患者痳醉效果滿意。兩組組間和組內血流動力學及組間痳醉起效時間、阻滯完善時間及痳醉閤併癥、不良反應髮生率比較差異均無統計學意義(P>0.05)。術畢 A 組 Bromage 評分分級明顯低于 B 組，差異有統計學意義(P<0.01)。結論兩種比重的鹽痠囉哌卡因註射液單側腰硬聯閤阻滯方法均可安全有效地用于老年髖關節手術患者，而輕比重 CSEA 術畢對老年患者運動神經阻滯較輕，術後雙下肢保持瞭良好的運動功能，有利于患者術後早日康複。
목적：비교중비중여경비중염산라고잡인주사액단측요경연합마취(CSEA)용우노년관관절수술중적효과급기안전성。방법60례 ASA Ⅱ~Ⅲ급、택기행관관절치환수술적노년환자，수궤분위 A 조(경비중요마조)화 B 조(중비중요마조)，매조30례。관찰기록량조마취효과，마취기간수축압(SBP)、서장압(DBP)、심솔(HR)、혈양포화도(SpO2)적수치，마취기효시간，조체완선시간，마취합병증급불량반응，용 Bromage 법평정운동신경조체정황。결과소유환자마취효과만의。량조조간화조내혈류동역학급조간마취기효시간、조체완선시간급마취합병증、불량반응발생솔비교차이균무통계학의의(P>0.05)。술필 A 조 Bromage 평분분급명현저우 B 조，차이유통계학의의(P<0.01)。결론량충비중적염산라고잡인주사액단측요경연합조체방법균가안전유효지용우노년관관절수술환자，이경비중 CSEA 술필대노년환자운동신경조체교경，술후쌍하지보지료량호적운동공능，유리우환자술후조일강복。
Objective To compare effects and safety between hyperbaric and hypobaric ropivacaine in unilateral combined spinal epidural anesthesia (CSEA) for senile hip joint surgery. Methods A total of 60 ASA Ⅱ~Ⅲ senile patients receiving hip joint surgery were randomly divided into group A (hypobaric spinal anesthesia group) and group B (hyperbaric spinal anesthesia group), with 30 cases in each group. Observation and record were made on anesthetic effect, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), oxyhemoglobin saturation (SpO2) during anesthesia, anesthesia onset time, block complete time, anesthesia complications and adverse reactions in the two groups. Their motor nerve block status was evaluated by Bromage method. Results All the patients received satisfactory anesthetic effects. There were no statistically significant differences of haemodynamics, anesthesia onset time, block complete time, and anesthesia complications between the two groups and in each group (P>0.05). After operation, group A had much lower Bromage score than group B, and their difference had statistical significance (P<0.01). Conclusion Hyperbaric and hypobaric ropivacaine in unilateral combined spinal epidural anesthesia can be both applied for effective and safe senile hip joint surgery. Hypobaric CSEA provides slight motor nerve block and good double lower limbs motor function after operation. It is beneficial for early rehabilitation.
