高齡患者髖及下肢手術(shù)小劑量單側(cè)腰麻醉效果分析280例

摘 要 目的：探討高齡患者髖及下肢手術(shù)小劑量單側(cè)腰麻醉效果。方法：收治髖及下肢手術(shù)的高齡患者280例，隨機(jī)分成A、B兩組各10例，兩組均采用腰-硬聯(lián)合麻醉針穿刺，A組注入0.75%布比卡因0.6～1.2ml+10%葡萄糖0.8～1.5ml之重比重混合液1.5～2.5ml進(jìn)行麻醉；B組注入0.75%布比卡因1.3～1.8ml+10%葡萄糖1～2ml之重比重混合液2.5～3.5ml進(jìn)行麻醉。結(jié)果：兩組麻醉效果比較：A組麻醉前MAP（111.7±23.7）mmHg，麻醉后（107.5±21.8）mmHg，B組麻醉前（113.3±23.2）mmHg，麻醉后（97.3±24.7）mmHg。A組HR麻醉前（77.4±18.6）次/分，麻醉后（76.6±15.7）次/分，B組麻醉前（76.4±17.5）次/分，麻醉后（73.3±17.0）次/分，B組MAP、HR下降明顯，與A組比較差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論：小劑量單側(cè)腰麻在高齡患者髖及下肢手術(shù)麻醉效果好。

關(guān)鍵詞 高齡 髖骨 下肢 單側(cè)腰麻 小劑量

Abstract Objective：We want to investigate the effect of the elderly patients with hip and lower extremity operation using small dose of unilateral spinal anesthesia.Methods：We selected 280 patients in 2009 October to 2013 September，and these patients were randomly divided into A，B two groups.All two groups use combined spinal-epidural anesthesia.Group A was injected 1.5～2.5ml mixed liquid of anesthesia，the mixture is made up of 0.75% bupivacaine 0.6～1.2ml+10% glucose 0.8～1.5ml.Group B was injected 2.5～3.5ml mixed liquid of anesthesia，the mixture is made up of 0.75% bupivacaine 1.3～1.8ml+10% glucose 1～2ml.Results：The anesthesia effect of two groups is shown as follows：The MAP before anesthesia in group A is 111.7±23.7mmHg and is 107.5±21.8mmHg after anesthesia.The MAP before anesthesia in group B is 113.3±23.2mmHg and is 97.3±24.7mmHg after anesthesia.The HR before anesthesia in group A is 77.4±18.6/min and is 76.6±15.7/min after anesthesia.The HR before anesthesia in group B is 76.4±17.5/min and is 73.3±17.0/min after anesthesia.Results show that the B group of MAP and HR decreased significantly，the difference compared with the A group had significant difference（P<0.05）.Conclusion：The effect of unilateral spinal anesthesia with small dose in elderly patients with hip and lower extremity operation is good，and this method is worth spreading in clinic.

Key words Advanced age；Hip；lower limbs；Unilateral spinal anesthesia；Small dose

資料與方法

2009年10月-2013年9月收治髖及下肢手術(shù)的高齡患者280例，年齡73～84歲，平均78.1歲，ASA Ⅰ～Ⅲ級。術(shù)前合并肺心病14例，高血壓病91例，慢性支氣管炎42例，糖尿病42例。隨機(jī)分成A、B 兩組各10例，兩組在年齡、性別等方面差異無統(tǒng)計學(xué)意義，有可比性。

麻醉方法：兩組術(shù)前10分鐘肌注阿托品0.5mg、咪唑安定2.5mg。取側(cè)臥位，患肢在下，選L2～3或L3～4間隙，采用腰-硬聯(lián)合麻醉針穿刺[1]。硬膜外穿刺成功后，將腰麻針通過硬膜外穿刺針刺入蛛網(wǎng)膜下隙，見腦脊液后，A組注入0.75%布比卡因0.6～1.2ml+10%葡萄糖0.8～1.5ml之重比重混合液1.5～2.5ml進(jìn)行麻醉；B組注入0.75%布比卡因1.3～1.8ml+10%葡萄糖1～2ml之重比重混合液2.5～3.5ml進(jìn)行麻醉。

結(jié) 果

兩組麻醉效果比較：A組麻醉前MAP（111.7±23.7）mmHg，麻醉后（107.5±21.8）mmHg，B組麻醉前（113.3±23.2）mmHg，麻醉后（97.3±24.7）mmHg。HR麻醉前（77.4±18.6）次/分，麻醉后（76.6±15.7）次/分，B組麻醉前（76.4±17.5）mmHg，麻醉后（73.3±17.0）次/分，B組MAP、HR下降明顯，與A組比較差異有統(tǒng)計學(xué)意義（P<0.05），見表1。

討 論

腰麻在下肢手術(shù)中被廣泛使用[2，3]，但是，雙側(cè)普通劑量的腰麻對高齡患者有很大缺陷，因其阻滯范圍廣，易引起低血壓，而平均動脈壓下降導(dǎo)致冠脈血流減少，可能造成嚴(yán)重不良后果[4，5]。單側(cè)腰麻一般指一側(cè)的脊神經(jīng)根被阻滯，但是實際上并非阻滯局限于一側(cè)，而是兩側(cè)阻滯平面不對稱。如取側(cè)臥位，患側(cè)在下，使用重比重溶液，注射藥物時穿刺針斜面向下，可使患側(cè)阻滯平面高于健側(cè)，而且作用時間也長于健側(cè)。

由本文結(jié)果可見，小劑量單側(cè)腰麻在高齡病人髖及下肢手術(shù)麻醉效果好，值得臨床推廣。

參考文獻(xiàn)

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