【摘要】 目的探讨单侧腰麻在高龄患者髋及下肢手术的可行性和安全性。方法择期高龄患者髋及下肢手术30例,年龄71~85岁,男性20例,女性10例,体重45~65 kg,ASAⅢ~Ⅳ级,随机分为单侧腰麻USA组(U组)和硬膜外CEA组(C组),每组15例。穿刺点选择L3~4或L2~3椎间隙,U组取患侧卧位,抽取0.75%布比卡因1.8 ml加50%GS 0.2 ml以0.1 ml/秒速度注入,注药后取原体位卧10 min。C组常规硬膜外麻醉,以2%利多卡因2 ml为试验量,根据麻醉平面及患者反应追加全量0.5%布比卡因12~15 ml。记录麻醉起效时间,阻滞完全时间和辅助用药例数、腰麻后头痛、马尾综合症、恶心呕吐和布比卡因用量。结果两组患者年龄、体重、性别比、手术时间和输液量差异无显著性,两组血流动力学比较,差异无显著性,两组麻醉效果比较:腰麻组麻醉起效时间1.06±0.58 min,硬膜外组5.07±1.23 min;阻滞完善时间腰麻组6.71±2.27 min,硬膜外组18.74±4.83min;辅助用药腰麻组2例,硬膜外组13例;布比卡因用量U组9.21±0.42 mg,C组69.48±4.52 mg,以上结果硬膜外组与腰麻组比较(P<0.05),差异均有显著性。两组术后均无头痛、恶心呕吐、尿潴留、马尾综合症等并发症。结论只要掌握好适应症,麻醉中精心管理,单侧腰麻用于高龄患者也是安全可靠的麻醉方法之一。更多还原

【Abstract】 Aim To investigate the feasibility of unilateral spinal anesthesia for lower limb surgery in senile patients.Methods Thirty ASAⅢ~Ⅳ senile patients were assigned randomly into two groups:unilateral spinal anesthesia group(group U) and continual epidural anesthesia group(group C) with 15 cases each.0.75%bupivacaine1.2~1.4 ml added 50%GS was injected into arachnid space in group U;0.5% bupivacaine12~15 ml was intermittently injected into epidural space in group C.Observated effectual anesthesia time,sufficient anesthesia time,bupivacaine dosage of two group patients.All patients were recorded incidence of headache,nause,vomit,cauda equina syndrome after anesthesia.Results Age、weight、operationtime、infusion volume、parameter of two group patients were not different;Effectual anesthesia time in groupU(1.06±0.58)min,in groupC(5.07±1.23)min;Sufficient anesthesia time in groupU(6.71±2.27)min,in groupC(18.74±4.83)min:bupivacaine dosage in groupU(9.21±0.42)mg,in groupC(69.48±4.52)mg,there was significantly different between two groups(P<0.05)above demograghic data.There was no occurrence such as headache,nause,vomit,cauda equina syndrome in all patirnts.Conclusion Unilateral spinal anesthesia is one of safe and effective anesthesia mode during lower limb surgery in senile patients.更多还原