单侧连续腰麻用于老年冠心病人股骨头置换术的临床研究

目的:评价单侧连续腰麻(UCSA)用于高龄老年冠心病人股骨头置换术的临床效果.方法:选择行股骨头置换术的高龄老年冠心病人60例,随机分成UCSA组(I组)和连续硬膜外麻醉(CEA)组(Ⅱ组),每组30例.两组病人均选择L2～3为穿刺点.I组患肢在上行蛛网膜下腔穿刺插入Spinocath导管,注入0.375%左布比卡因轻比重液1 ml.Ⅱ组行硬膜外腔穿刺置管,1.5%利多卡因试探剂量3 ml.然后追加注入0.5%左布比卡因8 ml.观察两组感觉神经阻滞起效时间、平面扩散范围、运动神阻滞程度,监测记录麻醉前后各时点MAP、HR、sp02变化及心血管不良反应发生情况.结果:与Ⅱ组比较,I组感觉神经阻滞起效快,改良Bromage评分升高(P<0.05);术中心肌缺血、复杂性室早、低血压及心率缓慢发生率降低(P<0.05);与T0比较,I组MAP、HR、Sp02在麻醉后各时点无明显变化(P>0.05),Ⅱ组MAP在T4～7、HR在T4～5、Sp02在T5～6降低(P<0.05).结论:UCSA起效快,阻滞完善,循环功能较平稳,是高龄老年冠心病人股骨头置换术的一种较好麻醉方法.

Clinical study of unilateral continuous spinal anesthesia in elderly patients with coronary heart disease undergoing hip replacement

Objective：To evaluate the effect of using unilateral continuous spinal anesthsia（UCSA） in elderly patients with coronary heart disease（CHD） undergoing hip replacement.Methods：Sixty ASA Ⅱ～Ⅲ patients aged 80～99 years were randomly divided into two groups,30 patients in each group,groupⅠ（UCSA） and group Ⅱ continuous epidural anesthesia,CEA.In group Ⅱ,subarachnoid space puncture was preformed at the lateral position with the deseased leg upper most and Spinocath catheter was placed at L2.3.Hypobaric 0.375% levobupivacaine solution 1.0 ml was injected.In group Ⅱ,epidural catheter was placed at L2.3.After a test dose of 3 mL of 1.5% lidocaine,8 mL of 0.5%.levobupivacaine was injected into the epidural space.The time and level of sensory block and the degree of motor block were measured.MAP,HR,SpO2 of pre-anesthesia and post-anesthesia were monitored.Cardiovascular advers reactions were recorded.Results：The onset of block in group Ⅰwas significantly faster than that in the group Ⅱ.Motor blockade was more intense in group Ⅰ as assessed by modified Bromage score.Myocarial ischemia,the complexity of premature ventricular contraction,hypotension,bradycardia in groupⅠ were lower than that in groupⅡ.MAP,HR and SpO2 were decresed separately at T4～7,T4～5,T5～6 in group Ⅱ.Conclusion：UCSA with the advantages of faster onset of block,better analgesia,stable hemodynamics is a better anesthesia method of CHD in elderly people undergoing hip replacement.