连续蛛网膜下腔阻滞用于老年人下肢和盆腔手术的临床观察

目的探讨老年人下肢及下腹部手术中,连续蛛网膜下腔阻滞(CSA)麻醉效果和对血液动力学的影响。方法老年人下肢及下腹部手术60例,随机分为两组:CSA组和CEA组各30例。均取L2-3间隙行穿刺,CSA组以Spinocath导管置入蛛网膜下腔行连续蛛网膜下腔阻滞;CEA组硬膜外腔置入导管行硬膜外麻醉。分别记录感觉阻滞起效时间、最高阻滞平面、达最高阻滞平面的时间、给局麻药后30min时运动神经阻滞程度(改良Bromage评分,MBS)、血液动力学变化及术后并发症等情况。结果与CEA组比较,以小剂量的布比卡因用于CSA,感觉阻滞起效时间、达最高阻滞平面的时间显著缩短,MBS评分明显升高(P<0.05),给局麻药后平均动脉压(MAP)、心率(HR)在麻醉后各个时点分别与麻醉前比较,无明显差异。而CEA组的MAP和HR在给局麻药后20min(t4)、30min(t5)两个时点分别与麻醉前比较,均明显降低(P<0.05)。两组病人术后均无麻醉并发症。结论连续蛛网膜下腔阻滞较连续硬膜外麻醉有局麻药用量少、起效迅速、阻滞完善、肌肉松弛、血流动力学平稳等优点。Spinocath导管的连续蛛网膜下腔阻滞可以较安全地适用于老年人下肢及下腹部手术的麻醉。

Effects of continuous spinal anesthesia on hemodynamics in elderly patients

Objective] To observe the effects of continuous spinal anesthesia (CSA) on the hemodynamics in the elderly patients undergoing lower limbs and abdomen surgeries. Methods] 60 elderly patients scheduled for the lower limbs or abdomen surgery were randomly divided into two groups CSA (n=30) and CEA (n=30). The puncture was performed at the interspace of L2-3. Spinocath and epidural catheter was inserted respectively in group CSA and CEA. The changes of hemodynamics, the onset time of sensation block, the highest plane of analgesia, the time to reach complete motor blockade, movement of lower extremities (Modified Bromage Score, MBS ) at 30 min after received local anesthetic and postoperative complications were recorded. Result] Compared with group CEA, CSA used low dose Bupivacaine, the onset time of sensation block and the time to reach complete motor block decreased significantly respectively. Furthermore, the MBS were more higher (P <0.05). Compared with preanesthetic, mean arterial pressure (MAP) and heart rate (HR) of group CSA had no significant change, but MAP and HR of CEA decreased significantly at 20 min (t4), 30 min (t5) after received local anesthetic respectively (P <0.05). No postoperative complications occurred in these 60 cases. Conclusion] Compared with group CEA, CSA has the advantages of less local anesthetic, faster onset of block, better analgesia, more intense motor block, and more stable hemodynamics in elderly patients undergoing lower limbs and abdomen surgeries.