摘要
目的探讨罗哌卡因蛛网膜下腔阻滞麻醉用于老年患者单侧下肢闭合性骨折内固定手术的剂量。方法选择美国麻醉医师学会分级为Ⅰ～Ⅲ级且年龄≥65岁的老年患者60例,采用Dixon的up-and-down序贯法,第1例老年患者的蛛网膜下腔阻滞麻醉剂量设定为15mg,如阻滞完善则下1例患者的罗哌卡因剂量减少1个梯度(2.5mg),阻滞不全则下1例患者的罗哌卡因剂量增加1个梯度,直至研究结束。应用Probit回归分析计算罗哌卡因用于老年患者下肢手术蛛网膜下腔阻滞麻醉的局部麻醉药剂量及95%可信区间(CI)。记录术中、术后不良反应及血管活性药物的应用情况。结果老年患者行单侧下肢闭合性骨折内固定手术的罗哌卡因最高剂量为17.5mg,50%的老年患者罗哌卡因蛛网膜下腔阻滞麻醉下行下肢手术有效的局部麻醉药剂量(ED50,即最低有效剂量)为12.07mg(95%CI为10.93～13.29mg),95%的老年患者有效的局部麻醉药剂量(ED95)为16.77mg(95%CI为14.95～21.90mg),99%的老年患者有效的局部麻醉药剂量(ED99)为18.71mg(95%CI为16.30～25.78mg)。15.03mg对应85%的有效率,16.08mg对应92%的有效率。所有患者术中均未应用血管活性药物。围术期未出现恶心、呕吐等不良反应,术后出现蛛网膜下腔阻滞麻醉后头痛1例,经对症治疗后快速缓解。结论在老年患者下肢手术中应用罗哌卡因蛛网膜下腔阻滞麻醉是安全的,选择15mg的剂量可基本满足老年患者下肢手术的麻醉需要。
Objective To evaluate the proper dose of ropivacaine in spinal anesthesia for internal fixation for closed fracture of single lower limb in elderly patients.Methods Sixty elderly patients（ASA grade Ⅰ-Ⅲ,over 65 years old） scheduled for internal fixation for closed fracture of single lower limb were given ropivacaine as planned dose gradient（2.5 mg per gradient） with Dixon＇s up-and-down sequential method.The dosage of ropivacaine and 95% confidence interval（CI） for spinal anesthesia in elderly patients were calculated by Probit regression analysis.Adverse effect in the perioperative period and the usage of vasoactive agent were recorded.Results The maximal local anesthetic dose of ropivacaine used in spinal anesthesia for lower limb surgery in elderly patients was 17.5 mg.The median effective dose（ED50）,95% effective dose（ED95） and 99% effective dose（ED99） were 12.07 mg（95%CI=10.93-13.29 mg）,16.77 mg（95%CI=14.95-21.90 mg）,and 18.71 mg（95%CI=16.30-25.78 mg）,respectively.The 85% effective dose（ED85） and 92% effective dose（ED92） were 15.03 mg and 16.08 mg,respectively.Vasoactive drugs were not applied in the patients.No adverse effects,such as nausea and vomiting happened in the perioperative period.Headache occurred in one patient after surgery and was released by symptomatic treatment.Conclusion Spinal anesthesia with ropivacaine is safe for orthopedic surgery of lower limb in elderly patients.The dose of 15 mg can be chosen the ropivacaine as the appropriate request for anesthesia.（Shanghai Med J,2012,35：837-840）
出处
《上海医学》
CAS
CSCD
北大核心
2012年第10期837-840,共4页
Shanghai Medical Journal
