椎管内麻醉不同给药方式对老年下肢骨科手术效果观察

目的 探讨左旋布比卡因椎管内不同给药方式对老年下肢骨科手术的麻醉效果.方法 42例实施下肢骨科手术的老年患者,随机分为Ⅰ组和Ⅱ组,每组21例.Ⅰ组为连续硬膜外间隙给药模式：左布比卡因0.375%溶液5～12 ml分次注入.Ⅱ组采用针内套针法腰-硬联合给药模式,蛛网膜下腔麻药用量为0.5%左旋布比卡因2 ml（0.75%左旋布比卡因10 mg＋脑脊液1 ml）,注药后留置硬膜外导管备用.全程监测并记录注药后5、10、15、20 min各时点循环和呼吸参数变化及麻黄素用量.记录两组局麻药用量、麻醉起效时间并观察麻醉效果.结果 Ⅱ组的局麻药用量明显少于Ⅰ组（P＜0.05）,Ⅰ组麻醉起效时间为（18.0±3.5）min,Ⅱ组为（7.0±1.5）min,与Ⅰ组比较差异有统计学意义（P＜0.05）.两组麻醉效果优良率分别为80.95%、19.05%和95.23%、4.77%,Ⅱ组优于Ⅰ组.两组患者于注药后5、10、15、20 min各时点血压均有不同程度下降,Ⅰ组血压下降较为缓慢,Ⅱ组T1、T2血压下降幅度较Ⅰ组大（P＜0.05）,但下降值均在基础值的30%以内.结论 左旋布比卡因腰硬联合阻滞用于老年下肢骨科手术效果确切,对循环和呼吸功能影响较小.

Clinical effects comparison of two anesthesia methods for lower limb orthopedic surgery in senile patients

Objective To compare the effects of different intraspinal anesthesia techniques of lower limb orthopedic surgery in senile patients. Methods 42 patients undergoing lower limb orthopedic surgery were randomly divided into two groups of 21 cases：CEA group, CSEA group. In CEA group,the patients would receive sequential solution of 0. 375% L- bupivacaine, in CSEA group,0.5% 1, - bupivacaine（ 10 mg 0.75% 1, - bupivacaine plus lml cerebrospinal fluid）were injected while the catheter was inserted ＇after the injection. Monitor and record the changes of cireulation and respiration parameters and the dosage of ephedrine at each time point of 5,10,15,20 minutes after injection. The onset time and effect of anesthesia were compared. Results Amount of L - bupivacaine consumptions were remarkably higher in CSEA group than in CEA group （ P 〈 0.05 ）. The onset time was （ 18. 0 ± 3.5 ） rain, （ 7.0 ± 1.5 ） min in CEA group and CSEA group （ P 〈 0.05 ）. The effect of anesthesia in CSEA group（ 95.23% ,4.77% ） was better than CEA group（ 80.95%, 19.05% ）. Hypotension after anesthesia appeared in both group at each time points of 5,10,15,20 minutes. The reduction in blood pressure in CSEA group was higher than that of CEA group（P 〈0.05）. Conclusion L-bupivacaine combined spinal -epidural anesthesia is recommended due to the most stable Circulation and Respiratory fnnction for lower limb orthopedic surgery in senile patients.