腰麻硬膜外联合麻醉在老年下肢手术中的临床观察

目的:比较罗哌卡因、左旋布比卡因和布比卡因在老年患者下肢手术腰麻—硬膜外联合麻醉(combined spinal epidural anesthesia,CSEA)应用中的麻醉效果.方法:60例拟行下肢手术的老年患者随机分为罗哌卡因组、左旋布比卡因组和布比卡因组,每组各15例,均采用CSEA麻醉方法.比较各组感觉、运动麻醉阻滞情况,以及血流动力学变化.结果:罗哌卡因组麻醉效果不及其他两组,而布比卡因组与左旋布比卡因组间比较麻醉效果差异不明显；与其他两组比较,罗哌卡因组麻醉起效时间及最大运动阻滞时间均显著延长,而阻滞恢复时间明显缩短(P＜0.05或0.01),且Bromage评分及麻醉满意率低于布比卡因组(P＜0.05)；罗哌卡因组与左旋布比卡因组患者循环系统稳定性优于布比卡因组.结论:腰麻—硬膜外联合麻醉中罗哌卡因、左旋布比卡因和布比卡因对于老年患者下肢手术均有较好的麻醉效果,其中罗哌卡因、左旋布比卡因对于心血管影响较小.

Clinical Research of Combined Spinal-epidural Anesthesia in Elderly Patients Undergoing Lower Extremity Surgery

Objective： To evaluate the effect of ropivacaine,levobupivacaine and bupivacaine in application of combined spinalepidural anesthesia on elderly patients undergoing lower extremity surgery.Methods： Sixty elderly patients undergoing lower extremity surgery was randomly divided into ropivacaine group,levobupivacaine group and bupivacaine group,with 15 cases each group.All patients received combined spinal-epidural anesthesia.The sensory and motor block was recorded and analyzed,as well as the dynamic changes and adverse reaction.Results： Better analgesic effects were found in the levobupivacaine and bupivacaine group than in ropivacaine group,but there was no obvious difference between them.Compared with the other groups,the onset time of block and time of maximum motor block in ropivacaine group were longer,but the recovery time of sensory and motor block were shorter（P0.05 or 0.01）.Bromage score and satisfactory rate in ropivacaine group was significantly lower than bupivacaine group（P0.05）.The ropivacaine and levobupivacaine provided stable haemodynamics during surgery,but not in the bupivacaine group.Conclusion： The ropivacaine,levobupivacaine and bupicavaine could cause good analgesic effects on elderly patients undergoing lower extremity surgery when using CSEA,and there was less influence on cardiovascular system by ropivacaine and levobupivacaine.