【摘要】 目的比较连续脊麻、腰硬联合麻醉和连续硬膜外腔阻滞在70岁以上患者人工关节置换术中的临床效应。方法60例71～98岁择期人工关节置换术患者〔美国麻醉医师协会(ASA)体格情况评级Ⅱ～Ⅲ级〕分为连续脊麻组、腰硬联合麻醉组和硬膜外腔阻滞组,每组20例。采取0.5%布比卡因分次小量给药的方法使麻醉无痛平面达胸椎10(T10)。结果各组麻醉效果良好;连续脊麻组运动阻滞评级高于硬膜外腔阻滞组;布比卡因用量以连续脊麻组〔(8.0±1.8)mg〕最小,腰硬联合麻醉组的〔(13.7±9.7)mg〕稍大,硬膜外腔阻滞组〔(39.4±16.6)mg〕最大,差异均有统计学意义(P<0.01或P<0.05)。平均动脉压最大抑制程度,连续脊麻组(-7%)明显低于腰硬联合麻醉组(-23%)或硬膜外腔阻滞组(-22%);腰硬联合麻醉组的心脏指数最大下降幅度(-22%)大于连续脊麻组(-5%);使用麻黄素患者比例连续脊麻组(5%)低于硬膜外腔阻滞组(20%)或腰硬联合麻醉组(25%),差异均有统计学意义(P<0.01或P<0.05)。组间术中估计出血量、输血量和补液速度比较,差异均无统计学意义(P>0.05)。结论采取分次小量给药的方法,连续脊麻、腰硬联合麻醉和连续硬膜外腔阻滞均可应用于70岁以上患者人工关节置换术,其中以连续脊麻血液动力学影响最为轻微。更多还原

【Abstract】 Objective To compare clinical effects of continuous spinal, epidural and combined spinal-epidural anesthesia for arthroplasty in the elderly over 70 years. Methods Sixty geriatric patients, ASA status Ⅱ~Ⅲ degree, aged 71~98 yr, undergoing arthroplasty operation on hip or knee joint, were randomly assigned to group of continuous spinal anesthesia, group of combined spinal-epidural anesthesia, or group of continuous epidural anesthesia, with twenty patients of per group. T_ 10 anesthesia level was aimed by 0.5% bupivacaine titrated carefully. Results All anesthesia were clinically satisfied with average anesthesia level T_ 10(T_ 7~11). Bromage’s motor blockade scale in group of continuous spinal anesthesia was higher than that in group of continuous epidural anesthesia. Amount of bupivacaine consumptions were (8.0±1.8)mg, (13.7±9.7)mg, (39.4±16.6)mg in groups of continuous spinal anesthesia, combined spinal-epidural anesthesia, and continuous epidural anesthesia respectively (P<0.01~0.05). Maximum decrease of mean arterial pressure in group of continuous spinal anesthesia(-7%) was lower than that in group of continuous epidural anesthesia (-23%) or group of continuous epidural anesthesia(-22%). Maximum decrease of cardiac index in group of continuous spinal anesthesia (-5%) was lower than that in group of continuous epidural anesthesia(-22%). Cases of needing ephedrine treatment in group of continuous spinal anesthesia (5%) were fewer than that in group of combined spinal-epidural anesthesia (25%) and group of continuous epidural anesthesia (20%)(P< 0.01~0.05). There were no significant differences among the groups in blood losing, intravenous fluid infusion or blood infusion(P>0.05). Conclusions With 0.5% bupivacaine titrated carefully, all kinds of continuous spinal, epidural and combined spinal-epidural anesthesia are clinical efficient in the elderly over 70 years for arthroplasty, of which continuous spinal anesthesia is recommended due to the most stable hemodynamics.更多还原