布比卡因复合舒芬太尼用于老年患者蛛网膜下腔阻滞麻醉的临床观察

目的观察小剂量舒芬太尼复合布比卡因用于老年患者蛛网膜下腔阻滞麻醉(简称腰麻)的麻醉效果及不良反应。方法美国麻醉医师协会(ASA)Ⅰ～Ⅱ级、无腰麻禁忌、择期行下腹部及下肢手术的老年患者(60～81岁)90例,分为3组:单纯布比卡因组(B1、B2组)和布比卡因复合舒芬太尼组(BS组),每组30例。B1组:布比卡因15mg;B2组:布比卡因10mg;BS组:布比卡因10mg+舒芬太尼5μg。分别于注药前及注药后各时段记录:①呼吸、循环及镇静程度的监测结果:收缩压(SP)、舒张压(DP)、心率(HR)、血氧饱和度(SpO2)、呼吸频率(RR)、脑电双频指数(BIS);②麻醉效果:感觉阻滞起效时间、感觉阻滞达到的最高平面、感觉神经阻滞持续时间、运动神经阻滞程度及持续时间;③不良反应情况。结果①注药后3、5、15、30min时SP、DP:B2组、BS组与B1组之间差异有统计学意义(P<0.01);②感觉阻滞起效时间、感觉阻滞持续时间及感觉阻滞达到的最高平面:B1组、BS组与B2组比较差异有统计学意义(P<0.05);③B1组与B2组、BS组比较在给药后各时间段运动神经阻滞评分高,其差异有统计学意义(P<0.05);其运动阻滞持续的时间也明显延长(P<0.01);④不良反应差异无统计学意义,B2组、BS组与B1组比较,术中麻黄素的用量明显减少(P<0.05)。结论布比卡因复合舒芬太尼用于腰麻,可以更好地提高麻醉的安全性及精准性,尤其适用于老年患者。

Spinal anesthesia with sufentanil-bupivacaine in elderly patients

Objective To evaluate the quality of anesthesia and side effect on elderly patients of spinal anesthesia with low dose sufentanil-bupivacaine. Methods Ninety patients （60-81 year, ASA Ⅰ - Ⅱ ） undergoing spinal anesthesia were randomly divided into 3 groups （n=30）： Group B1, B2 and BS. Group B1 received 15 mg bupivacaine; Group B2 received 10 rag bupivacaine; Group BS received 10 mg bupivacaine ＋ 5 p.g sufentanil. The volume was 3 ml in every group. SP, DP, HR, RR, BIS, SpOt, the degree and duration of motor and sensory blockade and the side effect were observed. Results （1） SP/DP was significantly decreased in Group B1 than that in Group B2 and Group BS （P〈0.01） in 3, 5, 15, and 30 min after the injection. （2） The onset time of sensory blockade, highest sensory blockade level, the regression time of sensory blockade were obviously differentin Group Bin, BS than that in Group B2 （P〈0.05）. （3） The complete recovery time of motor nerve eblockade was obviously prolonged in Group B1 than that in Group B2, BS （P〈0.01） and the Bromage score was higher in Group B1 than that in Group B2, BS （P〈0.05）. （4） There were no significant differences in side effect among the three groups. The dosage of ephedrine was lower in Group BS and B2 than that in Group B1 （P〈0.05）. Conclusion Spinal anesthesia with low dose sufentanil-bupivacaine provided safe and effective anesthesia for elderly patients.