国际麻醉学与复苏杂志   2017, Issue (2): 0-0
    
0.33%等比重罗哌卡因蛛网膜下腔阻滞在高龄半髋关节置换术中的应用研究
查本俊, 熊华平, 谢平, 胡吉, 贾广瑞1()
1.福建省泉州市解放军第180医院
Clinical analysis on 0.33% isobaric ropivacaine for spinal anesthesia in elderly patients undergoing hemiarthroplasty of the hip
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摘要：

目的　评价0.33%等比重罗哌卡因蛛网膜下腔阻滞在高龄半髋关节置换术中应用的安全性和有效性。　方法　年龄≥70岁，ASA分级Ⅱ、Ⅲ级，行半髋关节置换术的患者150例，按随机数字表法分为A组、B组、C组（每组50例）。所有患者均采用健侧卧位，穿刺间隙为L3~L4椎间隙，用脑脊液将1%盐酸罗哌卡因注射液稀释成0.33%（1 ml罗哌卡因+2 ml脑脊液），A组、B组、C组分别给予2.2、2.0、1.8 ml。于麻醉前（T0），蛛网膜下腔注药后5 min （T1）、10 min（T2）和15 min（T3），手术开始时（T4），手术开始后30 min（T5），术毕（T6）时点，记录MAP、HR和感觉阻滞平面高度，并记录麻醉诱导时间、手术时间、术中出血量、尿量和输液量以及术中、术后相关并发症。　结果　蛛网膜下腔阻滞有效率和阻滞效果A组明显优于B组、C组，且B组优于C组（P＜0.05）。麻醉诱导时间A组［（15.6±1.4） min］明显短于B组［（19.5±6.3） min］、C组［（26.6±7.1） min］，且B组短于C组（P＜0.05）。HR 在A组T1~T6时［（80±12）、（80±11）、（78±10）、（77±10）、（77±10）、（77±10） 次/min］和B组T1~T2时［（77±8）、（77±7） 次/min］较各组T0时［（71±11）、（73±9） 次/min］明显增快（P＜0.05）；MAP在A组T1、T2时［（96±8）、（98±8） mmHg（1 mmHg=0.133 kPa）］、B和C组T4~T6时［（100±8）、（100±8）、（100±8） mmHg和（96±8）、（98±7）、（99±8） mmHg］较各组T0时［（104±8）、（104±8）、（103±8） mmHg］均明显降低（P＜0.05），且C组T4~T6时较T3时也明显降低（P＜0.05）。T1~T3时A组感觉阻滞平面明显高于B组和C组，且B组高于C组（P＜0.05）；在T4~T6时A组和B组明显高于C组（P＜0.05）；与T3比较，A组感觉阻滞平面在T6时明显降低（P＜0.05）；B组、C组感觉阻滞平面在T4~T6时明显升高（P＜0.05）。术中低血压和恶心呕吐的发生率A组、B组均明显低于C组（P＜0.05），而A组和B组比较，差异均无统计学意义（P＞0.05）。　结论　0.33%等比重罗哌卡因蛛网膜下腔阻滞应用于高龄半髋关节置换术中具有安全性和有效性。
关键词： 罗哌卡因；　蛛网膜下腔阻滞；　半髋关节置换术
Abstract:

Ｏｂｊｅｃｔｉｖｅ　To analyse the safety and effectiveness of 0.33% isobaric ropivacaine for spinal anesthesia in elderly patients undergoing hemiarthroplasty of the hip.　Methods　one hundred and fifty aged≥70, ASA Ⅱ or Ⅲ patients who undergoing hemiarthroplasty of the hip, were randomly divided into three groups(n=50). Lumbar puncture at the L3-L4 interspinous spaces was performed in the non-surgical lateral decubitus for all patients. 1% ropivacaine was diluted to 0.33% ropivacaine with cerebrospinal fluid(1 ml ropivacaine+2 ml cerebrospinal fluid). Group A, B and C received 0.33% ropivacaine 2.2, 2.0, 1.8 ml, respectively. MAP, HR, sensory block level were recorded in 6 different timing: before receiving ropivacaine(T0), after receiving ropivacaine 5 min(T1), 10 min(T2), 15 min(T3), beginning of surgery(T4), at 30 min after beginning of surgery(T5), the end of surgery(T6). The time for induction of anesthesia, operation time, blood loss, urine volume, volume of fluid infused complications at the intraoperation and postoperation were also recorded.　Results　The rate of effective spinal anesthesia and anesthetic effects in the group A were better than in group B and group C, and in group B were also better than in group C(P＜0.05）. The time for induction of anesthesia in the group A［(15.6±1.4) min］ was shorter than in group B and group C［(19.5±6.3), (26.6±7.1) min］, and in group B were also shorter than in group C(P＜0.05）. HR in group A at T1-T6［(80±12), (80±11), (78±10), (77±10), (77±10), (77±10) bpm］, group B at T1-T2［(77±8), (77±7) bpm］ were faster than each group at T0［(71±11), (73±9) bpm］(P＜0.05), MAP in group A at T1-T2［(96±8), (98±8) mmHg (1 mmHg=0.133kPa)］, group B and group C at T4-T6［(100±8), (100±8), (100±8) mmHg and (96±8), (98±7), (99±8) mmHg］ were lower than at T0［(104±8), (104±8), (103±8) mmHg］(P＜0.05), and in group C at T4-T6 was lower than at T3(P＜0.05). Sensory block level at T1-T3 in group A was higher than in group B and group C, and in group B was higher than in group C. Sensory block level at T4-T6 in group A and group B were higher than in group C(P＜0.05). Compared with T3, sensory block level in group A at T6 was lower and in group B and group C at T4-T6 were higher(P＜0.05). The rate of hypotension, nausea and vomiting in group A and group B were lower than in group C(P＜0.05), and there was no significant difference between group A and group B (P＞0.05).　Conclusions　0.33% isobaric ropivacaine for spinal anesthesia in elderly patients undergoing hemiarthroplasty of the hip is safe and effective.
Key words: Ropivacaine;　Spinal anesthesia;　Hemiarthroplasty of hip