0.5%轻比重罗哌卡因腰-硬联合麻醉在高龄患者侧卧位髋关节置换术中的应用

目的:探讨0.5%罗哌卡因轻比重腰-硬联合麻醉(CSEA)在有较严重合并症高龄患者侧卧位髋关节置换术中的应用安全性。方法:选择在CSEA下行髋关节置换手术的高龄患者80例,随机分为罗哌卡因组(R)和布比卡因组(B),均取患肢在上侧卧位,针内针法L2-L3穿刺,R组注入0.5%罗哌卡因6mg,B组注入0.5%布比卡因6mg,硬膜外腔头侧置管3cm。结果:R组感觉和运动阻滞起效时间、达最高阻滞平面时间均比B组长,但镇痛持续时间、最大Bromage评分持续时间比B组短(P<0.05);R组收缩压、舒张压、心率、脉搏血氧饱和度比B组更平稳,不良反应比B组少;血清肾素、血管紧张素Ⅱ、醛固酮浓度B组下降较R组明显。结论:0.5%罗哌卡因轻比重单侧腰麻-硬膜外联合阻滞应用于合并心肺功能不全、高黏血症等高龄患者侧卧位髋关节置换术安全有效。

Application of 0.5% Hypobaric Ropivacaine and Bupivacaine in Combined Spinal-Epidural Anesthesia in Elderly Patients Undergoing Hip Replacement at Lateral Position

Objective:To investigate the application safety and effect of combined spinal-epidural anesthesia (CSEA) with 0.5% hypobaric ropivacaine for the elderly with serious complications undergoing lateral position of hip replacement. Methods:Eighty elderly patients scheduled for lateral position of hip replacement with CSEA were randomly divided into group R and group B,which were anaesthetized by ropivacaine and bupivacaine respectively. Results:Onset time and time to maximal level of sensory block and motor block were longer in group R than those in group B respectively,while duration time of analgesia and maximal Bromage score in group R were shorter (all P<0.05). Compared with those in group B,systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR) and pulse oxygen saturation (SpO2) were more stable and side effects were less in group R (all P<0.05). The concentrations of plasma rennin activity (PRA),angiotensin Ⅱ(ATⅡ) and aldosterone (ALD) in group R were higher than those in group B respectively (all P<0.05). Conclusion:Unilateral CSEA with 0.5% hypobaric ropivacaine is safe and effective for the elderly with cardiopulmonary function incompetence and blood hyperviscosity undergoing hip replacement.