低浓度罗哌卡因腰麻在高龄患者下肢手术中的可行性研究

目的评价高龄患者骨科下肢手术低浓度罗哌卡因应用的可行性。方法择期骨科下肢手术的高龄病人46例，临床观察随机分为腰麻（sA）A组和连续硬膜外阻滞组（CEA）B组，两组均选L2-3或L3-4间隙行椎管内麻醉；A组蛛网膜下腔穿刺成功后，注入0．375％罗哌卡因重比重液2ml，B组行硬膜外穿刺置管注入2％利多卡因试验量3ml，然后追加1．O％利多卡因和O．25％罗哌卡因混合液6～8ml，术中根据阻滞平面追加上述局麻药，观察两组在麻醉前（TO）和给予首剂量麻醉药后5min（T1）、15min（T2）、30min（T3）、lh（T4）、术毕（T5）相关指标，比较两组感觉阻滞平面，改良的Bromage评分，观察下肢运动恢复情况，术中及术后24h心动过缓、低血压、恶心、呕吐、头痛、神经系统并发症的发生率。结果与TO比较，A组平均动脉压（MAP）在Tl-T5降低，B组MAP在T2-T5降低（P〈0．05或P〈0．01）：与B组比较，A组术中低血压的发生率及术后寒战，恶心，呕吐发生率均降低（P〈0．05）；与B组比较，A组患者感觉阻滞平面降低，改良Bromage评分升高（P〈0．05）。结论sA较CEA感觉运动神经阻滞完善，血流动力学平稳，并发症少，用于高龄骨科下肢手术病人是可行的。

Spinal anesthesia with low - concentration ropivacaine in elderly patients undergoing lower extremity surgery

Objective To explore the feasibility of spinal anesthesia (SA) with low-concentration ropivacaine in elderly patients undergoing lower extremity surgery. Methods Forty-six patients were randomized to one of the two groups: group A (SA,n=23) and group B (continuous epidural anesthesia CEA,n=23). The patients in both groups were premedicated with luminal 100 mg. In group A , SA was performed at L2-3 or L3-4 interspace. 0.375% ropivacaine 2 ml was injected. In group B, epidural catheter was placed also at L2-3 or L3-4. A test dose of 3ml of 2% lidocaine was injected and then a mixture of 1.0% lidocaine and 0.25% ropivacaine. Degree of motor blockade were measured and recorded. The intraoperative and postoperative complications associated with spinal or epidural anesthesia were recorded. Results In group A, MAP was slightly decreased after initial dose of local anesthetics compared to the baseline MAP in both groups. The incidences of hypotension, which needed treatment with intravenous ephedrine, shivering during operation, and postoperative nausea and vomiting in group A were significantly lower than group B. Conclusions Compared with CEA, SA produced satisfactory sensory block with less hemodynamic changes and less complications. It is the choice for elderly patients undergoing lower extremity surgery.