摘要
目的罗哌卡因目前已广泛用于硬膜外阻滞、外周局部神经阻滞和术后镇痛,但其用于轻比重腰麻的报道尚不多见。文中研究观察轻比重罗哌卡因用于髋关节置换手术的临床效果。方法选择65岁以上、美国麻醉医师学会(ameri-can society of anesthesiologists,ASA)Ⅰ～Ⅲ级、行人工髋关节置换术的患者80例。于L2-3行腰部蛛网膜下腔和硬膜外联合穿刺后,根据注入腰麻药液的不同,随机分为4组。试验组第1组为0.75%罗哌卡因2 ml+灭菌注射用水1 ml,第2组为0.75%罗哌卡因1.5 ml+灭菌注射用水1.5 ml,第3组为0.75%罗哌卡因1 ml+灭菌注射用水2 ml;对照组为0.5%布比卡因2 ml+5%葡萄糖溶液1 ml。记录感觉阻滞起效时间、运动阻滞起效时间、最高阻滞平面、麻醉维持时间、最大运动阻滞程度、最大运动阻滞时间、感觉及运动恢复时间,并观察术中用药情况及不良反应。结果 4组患者在感觉阻滞起效时间、最高阻滞平面及完全阻滞患者比例的差异均无统计学意义。试验组Ⅲ的运动阻滞起效时间与对照组和试验组Ⅰ相比显著延长(P<0.01)。患侧最大Bromage评分、麻醉持续时间、感觉及运动恢复时间:对照组>试验组Ⅰ>试验组Ⅱ>试验组Ⅲ(P<0.05或P<0.01)。试验组Ⅰ有1例出现心率、血压下降现象,试验组Ⅲ有2例(10%)出现阻滞不完全。结论轻比重罗哌卡因11.25mg腰麻用于老年人髋关节置换手术可达到完全镇痛效果,安全性较高。
Objective Ropivacaine has been widely used in epidural anesthesia,peripheral nerve block and postoperative analgesia of local,but reports on spinal anesthesia with hypobaric ropivacaine are rare yet.This research is to observe the clinical effect of hypobaric ropivacaine in spinal anesthesia in the elderly undergoing hip replacement.Methods Eighty patients,65 years or older,ASA class Ⅰ-Ⅲ,scheduled for hip replacement,were randomly allocated to 4 groups.A spinocath catheter was advanced 3cm into subarachnoid space at L2-3 interspace.Experimental group,group Ⅰ： 0.75% ropivacaine 2ml＋sterile water for injection 1ml,group Ⅱ： 0.75% ropivacaine 1.5ml＋sterile water for injection 1.5ml,group Ⅲ： 0.75% ropivacaine 1ml＋sterile water for injection 2ml;Control group： 0.5% bupivacaine 2ml＋5% glucose 1ml.The onset time of sensation and motor block,the highest plane of analgesia,the time to reach the highest plane of analgesia,the degree of motor block,the time of the sensation and motor regressive and the adverse effects were recorded.Results There was no significant difference in sensory block including onset time and maximum cephalad spread level among 4 groups.The complete sensory block appeared in most patients.The onset time and duration of motor blockage in Experimental group Ⅲ were longer than those in Control group and Experimental group Ⅰ（P0.01）.On the affected extremity,the maximum Bromage score,duration of anesthesia,sensory or motor regressive time in Control group were higher or longer than those in all Experimental groups（P0.05 or P0.01）.Descending of heart rate and blood pressure occurred on one patient in Experimental group Ⅰ,and 2 patients in Experimental group Ⅲ had incomplete blockage.Conclusion Continuous spinal anesthesia with hypobaric ropivacaine 11.25 mg is safe and efficient for hip replacement surgery in elderly patients.
出处
《医学研究生学报》
CAS
2010年第5期489-491,共3页
Journal of Medical Postgraduates
基金
南京军区医药卫生科研基金(06MA131)
关键词
罗哌卡因
腰麻
布比卡因
老年
髋关节置换术
Ropivacaine
Spinal anesthesia
Bupivacaine
Gerontism
Hip replacement
