盐酸罗哌卡因复合舒芬太尼行腰硬联合麻醉在老年患者盆底重建术中的观察

目的：观察盐酸罗哌卡因复合舒芬太尼行腰硬联合麻醉在老年患者盆底重建术中剂量选择，及对血流动力学的影响。方法：选择择期盆底重建手术患者60例选择L2～3棘间隙为穿刺点，随机分为3组，每组20例，盐酸罗哌卡因10m g（P1）组、盐酸罗哌卡因8mg复合5μg舒芬太尼（P2）组和盐酸罗哌卡因6mg复合10μg舒芬太尼（P3）组，每组均回抽脑脊液配2ml混合液，缓慢推注（40秒），.记录三组感觉阻滞起效时间，感觉阻滞维持时间，运动阻滞起效时间，运动阻滞维持时间，感觉阻滞最高平面，监测三组麻醉前（T0）,手术开始前（T1）,手术开始后10min（T2）,30min（T3），60min（T4）的平均动脉压，心率和血氧饱和度变化。结果：P2,P3组的运动阻滞维持时间均明显短于P1（P〈0.05）；感觉阻滞维持时间明显长于P1组（P〈0.05）；感觉阻滞最高平面，感觉阻滞起效时间，运动阻滞起效时间无明显差异（P〉0.05）。与P1组比较，P2 P3组术中心动过缓和低血压，寒战人数少于P1组（P〈0.05），瘙痒人数P3组明显多与P1 P2组。结论：盐酸罗哌卡因8mg复合5μg舒芬太尼可以保证手术中更为平稳的血流动力学状态，且无明显副反应，利于老年患者早期活动，值得临床推广应用，是安全可行的。

Observation of CSEA with Ropivacaine Hydrochloride Plus Sufentanil in Senile Patients Undergoing Pelvic Floor Reconstruction

Objective：To observe the dosing strategy of combined spinal epidural anesthesia （CSEA） with ropivacaine hydrochloride plus sufentanil in senile patients undergoing pelvic floor reconstruction and its hemodynamic effect. Methods：Sixty elective patients who underwent pelvic floor reconstruction with the puncture point between L2-3 interspace were randomized into three groups （n=20, respectively）：P1 （ropivacaine hydrochloride 10mg）, P2 （ropivacaine hydrochloride 8mg plus sufentanil 5μg） and P3 （ropivacaine hydrochloride 6mg plus sufentanil 10μg） groups. Cerebrospinal fluid （CSF） was withdrawn for each group to prepare a 2ml of the mixture, followed by bolus injection （for 40s）. Onset and hold times of the sensory and motor blocks along with the highest level of sensory block were recorded for three groups, and their changes in mean arterial pressure （MAP）, heart rate （HR） and oxygen saturation （SaO） were monitored before anesthesia （T0）, before （T1） and at 10 （T2）, 30 （T3） and 60min （T4） after the beginning of the surgery, respectively. Results：Both P2 and P3 groups had markedly shorter hold time of the motor block （P〈0.05） and longer hold time of the sensory block （P〈0.05） compared with P1 group;there were no significant differences in the highest level of sensory block, onset times of the sensory and motor blocks （P〉0.05）. Compared with P1 group, both P2 and P3 groups had fewer patients with intraoperative bradycardia, hypotension and chills （P〈0.05）, P3 group had markedly more patients with itching than P1 and P2 groups. Conclusion：It is valuable safe and feasible in clinical application that ropivacaine hydrochloride 8mg plus sufentanil 5μg can guarantee a steadier intraoperative hemodynamic status without obvious side effects and facilitate early mobilization for senile patients.