摘要
目的:评价单侧连续腰麻(UCSA)用于高龄老年冠心病人股骨头置换术的临床效果。方法:选择行股骨头置换术的高龄老年冠心病人60例,随机分成UCSA组(Ⅰ组)和连续硬膜外麻醉(CEA)组(Ⅱ组),每组30例。两组病人均选择L2～3为穿刺点。Ⅰ组患肢在上行蛛网膜下腔穿刺插入Spinocath导管,注入0.375%左布比卡因轻比重液1ml。Ⅱ组行硬膜外腔穿刺置管,1.5%利多卡因试探剂量3ml,然后追加注入0.5%左布比卡因8ml。观察两组感觉神经阻滞起效时间、平面扩散范围、运动神经阻滞程度,监测记录麻醉前后各时点MAP、HR、SpO2变化及心血管不良反应发生情况。结果:与Ⅱ组比较,Ⅰ组感觉神经阻滞起效快,改良Bromage评分升高(P<0.05);术中心肌缺血、复杂性室早、低血压及心率缓慢发生率降低(P<0.05);与T0比较,Ⅰ组MAP、HR、SpO2在麻醉后各时点无明显变化(P>0.05),Ⅱ组MAP在T4～7、HR在T4～5、SpO2在T5～6降低(P<0.05)。结论:UCSA起效快,阻滞完善,循环功能较平稳,是高龄老年冠心病人股骨头置换术的一种较好麻醉方法。
Objective：To evaluate the effect of using unilateral continuous spinal anesthsia（UCSA） in elderly patients with coronary heart disease（CHD） undergoing hip replacement.Methods：Sixty ASA Ⅱ～Ⅲ patients aged 80～99 years were randomly divided into two groups,30 patients in each group,groupⅠ（UCSA） and group Ⅱ continuous epidural anesthesia,CEA.In group Ⅱ,subarachnoid space puncture was preformed at the lateral position with the deseased leg upper most and Spinocath catheter was placed at L2.3.Hypobaric 0.375% levobupivacaine solution 1.0 ml was injected.In group Ⅱ,epidural catheter was placed at L2.3.After a test dose of 3 mL of 1.5% lidocaine,8 mL of 0.5%.levobupivacaine was injected into the epidural space.The time and level of sensory block and the degree of motor block were measured.MAP,HR,SpO2 of pre-anesthesia and post-anesthesia were monitored.Cardiovascular advers reactions were recorded.Results：The onset of block in group Ⅰwas significantly faster than that in the group Ⅱ.Motor blockade was more intense in group Ⅰ as assessed by modified Bromage score.Myocarial ischemia,the complexity of premature ventricular contraction,hypotension,bradycardia in groupⅠ were lower than that in groupⅡ.MAP,HR and SpO2 were decresed separately at T4～7,T4～5,T5～6 in group Ⅱ.Conclusion：UCSA with the advantages of faster onset of block,better analgesia,stable hemodynamics is a better anesthesia method of CHD in elderly people undergoing hip replacement.
出处
《现代医药卫生》
2010年第12期1761-1763,共3页
Journal of Modern Medicine & Health
关键词
单侧连续腰麻
老年冠心病人
股骨头置换术
Unilateral continuous spinal anesthesia
Coronary heart disease in elderly people
Hip replacement
