罗哌卡因腰硬联合麻醉应用于老年下腹部或下肢手术病人

目的：探讨罗哌卡因腰硬联合麻醉（CSEA）用于老年病人下腹部或下肢手术的可行性。方法：40例行下腹部或下肢手术的老年病人，硬膜外麻醉组（CEA）、CSEA组，每组20例。记录两组麻醉平面满意时的时间，以改良Bromage评分法评定下肢运动神经阻滞的程度，于麻醉前（T0）、麻醉平面满意时（T1）、切皮后1h（T2）、术毕（T3）监测平均动脉压（MAP）、心率（HR），记录两组病人辅用麻黄碱、氟芬合剂的情况，观察下肢运动功能恢复情况。结果：k期间，CEA组有15例、CSEA组有3例病人需辅用麻黄碱（P〈0．01）。与CEA组比较，CSEA组麻醉起效时间及运动功能恢复时间明显缩4a（P〈0．05）；CSEA组Brornage评分高于CEA组（P〈0．05）；CEA组有10例、CSEA组有2例病人需辅用氟芬合剂（P〈0．05）。CSEA组无并发症。结论：罗哌卡因CSEA用于老年下腹部或下肢手术病人，可产生良好的麻醉效果，且无明显副作用。

The application of combined spinal and epidural anesthesia with ropivacaine in elderly patients undergoing lower abdominal or lower extremity surgery

Objective： To evaluate the feasibility of using combined spinal and epidural anesthesia（CSEA） with ropivacaine in elderly patients undergoing lower abdominal or lower extremity surgery. Methods： Forty elderly patients undergoing lower abdominal or lower extremity surgery were randomixed to receive epidural anesthesia（CEA） （n=20） or CSEA（n=20）. The onset time of anesthesia was recorded .The degree of motor block was assessed using modified Bromage scale. Arterial blood samples were obtained before anesthesia （To）, when satisfactory block level was reached （T1）, lh after skin after incision （T2） and at the end of operation （T3）. The amount of ephedrine and innovar used during operation and the recovery of motor function of lower extremities were also recorded. Results： Significantly more patients received ephedrine in CEA groupthan in CSEA group. The onset of block was significantly faster in CSEA group than in CEA group. Motor blockade was less intense in CEA group as assessed by modified Bromage scale. Less patients received innoar during operation in CSEA group than in CEA group .The recovery of motor function of lower extremities was faster in CSEA group than in CEA group. No late complications related to CSEA was observed. Conclusion： CSEA with ropivacaine is safe and effective in elderly patients.