0．75％罗哌卡因在高龄患者下肢手术中连续腰麻的应用观察

目的研究小剂量0．75％罗哌卡因连续腰麻用于高龄患者下肢手术的安全性和有效性。方法择期高龄下肢手术患者32例，年龄70～82岁，ASAⅡ-Ⅲ级，用随机数字表法分为罗哌卡因组和布比卡因组。两组分别以0．1ml／s在蛛网膜下腔分次小剂量注入0．75％罗哌卡因1ml或0．75％布比卡因1ml直至麻醉平面满意，比较两组患者痛觉阻滞程度、最高阻滞平面，运动阻滞程度（改良Bromage分级法），并且记录麻醉前（T0）、麻醉满意时（T1）、切皮后1．5h（T2）和术毕（B）HR、MAP的变化同时观察不良反应和并发症。结果两组患者均可达到完善的镇痛效果，但罗哌卡因组的镇痛起效时间、运动阻滞起效时间、最大运动阻滞时间均比布比卡因组显著延长（P〈0．05）；最高阻滞平面低于布比卡因组（P〈0．05）；而痛觉恢复时间、运动恢复时间比布比卡因组显著缩短（P〈0．05）；罗哌卡因组最大Bromage评分明显优于布比卡因组（P〈0．05）。结论小剂量0．75％罗哌卡因连续腰麻用于高龄老年患者下肢手术具有麻醉效果确切，对血流动力学影响小，不良反应少。临床上安全可行。

Observation of 0.75% Ropivacaine on the Elderly Lower Limbs Operation in CSA

Objective To observe the effects of 0.75% ropivacaine in continuous spinal anesthesia （CSA） in the elderly lower limbs operation. Methods 32 eases of elder with ASA Ⅱ-Ⅲ, age 70 - 82 years, were randomly divided into two groups （ R and B）, the patients was injected lml 0.75% ropivacaine or bupivacaine in spinal （0.1 ml/s）in L2-3 ,analgesia block,the highest nerve block level, movement block （modified Bromage degrees） were compared between two groups. Changes of heart rate and mean （HR） and mean arterial blood pressure （MAP） and side effect and complications during operation before anesthesia （T0） ,anaesthetizing satisfied （T1） ,after skin incision （T2 ） and time of complete of operation （T3 ） were recorded. Results Satisfied anesthesia was realized in both groups. The taking effect time of analgesia,movement blocking and maintain blocking time in group R were longer than those in group B（P 〈0.05） ;the highest blocking level in group R was lower than that in group B（ P 〈 0.05 ） ;the recovery time of analgesia and movement was shorter in group R than that in group B （P 〈 0.05 ） ;the Bromage score in group R was better than that in group B （P 〈 0.05）. Condusion 0.75% ropivacaine is safety and effective in CSA in the elderly lower limbs operation and with less influence on blood flow and side effect.