罗哌卡因腰硬联合麻醉在老年患者下肢手术中的应用

目的：探讨罗哌卡因腰硬联合麻醉应用于老年患者下肢手术的有效性和安全性。方法：选择在腰硬联合麻醉下择期行下肢手术的老年患者60例，随机分为2组，每组30例。Ⅰ组采用0．75％盐酸罗哌卡因1．2mL，Ⅱ组采用0．75％盐酸布比卡因1．2mL，均以脑脊液稀释后蛛网膜下腔给药，术中麻醉效果不佳时硬膜外腔追加1．5％利多卡因5—10mL。观察比较两组患者的感觉、运动阻滞情况和不良反应发生情况。结果：两组患者在感觉阻滞起效时间、最高感觉阻滞平面、T12阻滞维持时间方面，差异无统计学意义（P〉0．05）；与Ⅱ组相比，Ⅰ组患者运动阻滞起效时间长，最大Bromage评分小，Bromage 1分的维持时间短，差异有统计学意义（P〈0．05）；两组患者不良反应的发生率比较，差异无统计学意义（P〉0．05）。结论：罗哌卡因腰硬联合麻醉可安全有效地用于老年患者下肢手术。

Application of combined spinal epidural anaesthesia with ropivacaine in the lower extremity surgery on aged patients

Objective：To explore the effectiveness and safety of combined spinal-epidural anaesthesia with ropivacaine in the lower-extremity surgery on aged patients. Methods ：60 aged patients subjected to selective lower-extremity surgery with combined spinal-epidural anaesthesia were randomly divided into 2 groups,30 cases in each group. Patients in group Ⅰ were administrated with 1.2 mL （0.75%） ropivacaine hydrochloride, while those in group I1 were administrated with 1.2 mL （0.75 % ）bupivacaine hydrochloride. Above 2 kinds of anesthetic were injected into subarachnoid space after being diluted with cerebrospinal fluid. Additional 5 - 10 mL（ 1.5% ） lidocaine was injected into epidural space if the anesthetic was not enough for the surgery. The sensory function blockage ,motor function blockage and adverse reactions of patients in 2 groups were observed and compared. Results ： There was no statistical difference between the 2 groups on the aspect of sensory blockage acting time, the highest level of sensory blockage and Tl2 blockage duration time （P 〉 0.05 ）. Compared with Group Ⅱ, motor function blockage of GroupIwas delayed, the biggest Bromage scale was smaller and duration of 1-point Bromage scale was shorter（P 〈0.05）. There was no statistical difference on the incidence of adverse reactions between the 2 groups （P 〉 0.05 ）. Conclusion：Combined spinal-epidural anaesthesia with Ropivacaine is safe and effective for lower-extremity surgery on aged patients.