0.75%罗比卡因在高龄病人下腹部以下手术麻醉中的应用

目的观察0.75%罗比卡因用于65岁以上老年病人下腹部以下手术麻醉的效果及安全性。方法选择择期骨科、泌尿外科、妇科病人,年龄在70岁左右病人50例。根据手术种类选取L1~2或L2~3行硬膜外穿刺,头侧置管3.0~3.5 cm,给予1.6%利多卡因3~5 mL为实验量,无异常给予0.75%罗比卡因6~12mL观察阻滞平面及阻滞效果,同时观察Bp、HR、SPO2、ECG的变化并做医学统计。术毕,均经硬膜外途径做术后镇痛。结果全组病人首次用药后上界阻滞平面在T6~T8水平,麻醉效果满意,在2.5 h内无需追加用药,麻醉期间收缩压下降,超过3.93 kPa(30 mmHg)以上者占39%,其余均<2.66 kPa(20 mmHg),基本在可控范围。心率无明显变化,术后镇痛效果良好,术中、术后无明显呼吸抑制。结论在老年患者心肺功能尚可的情况下,行下腹部手术采用0.75%罗比卡因行硬膜外麻醉,具有阻滞效果完全,镇痛作用佳,作用时间长,在剂量不超过75 mg的前提下,患者呼吸、循环稳定,安全性高的优点,值得推广应用。

Application of 0.75 % Ropivacaine in Anesthesia of Hypogastric and Lower Operations of Elder

Objective To observe the anesthesia effect and safety of 0.75% ropivacaine in anesthesia of hypogastric and lower operations of elder patient.Methods 50 cases of elder patient around 70 years old who received the bone,urinary and gynaecological operation were performed epidural anesthesia at level of L 1,2 or L 2,3 with lidocaine test and then 0.75% ropivacaine.The blockage level and effect,Bp,HR,SPO_2 and ECG were observed.The analgesia was underwent after operation in all cases.Results The anesthesia level in this group was at TT with satisfied effect without respiratory inhibition and HR change.The BP was in the range of control during operation.Conclusion The epidural anesthesia of 0.75% ropivacaine might obtain the good blockage and analgesia with long duration and stable respiratory and circulation for elder patient.It might be safe and applicable.