2018 年第 7 期 第 13 卷

小剂量不同浓度罗哌卡因蛛网膜下腔麻醉在老年膝髋关节置换术中的应用效果

Effect of low dose ropivacaine subarachnoid anesthesia on elderly patients undergoing knee and hip arthroplasty

作者：纪秀波

英文作者：

单位：102618北京，中国中医科学院广安门医院南区麻醉科

英文单位：

关键词：膝髋关节置换术；罗哌卡因；蛛网膜下腔麻醉

英文关键词：

• 摘要：

• 【摘要】目的    观察小剂量不同浓度罗哌卡因蛛网膜下腔麻醉在老年膝髋关节置换术中的应用效果。方法    选取2016年6月至2017年6月中国中医科学院广安门医院收治的膝髋关节置换术老年患者92例，按照随机数字表法分为A组和B组，各46例。A组蛛网膜下腔注入0.50%的罗哌卡因；B组蛛网膜下腔注入0.25%的罗哌卡因。比较2组麻醉持续时间、运动恢复时间和感觉恢复时间；采用改良Bromage法评定手术侧下肢运动神经阻滞程度；观察不同时间心率和平均动脉压变化，以及不良反应发生情况。结果    B组麻醉持续时间、运动恢复时间和感觉恢复时间明显短于A组［（85±7）min比（103±10）min、（106±11）min比（127±14）min、（161±13）min比（196±15）min］，差异均有统计学意义（均P＜0.05）。B组手术侧下肢运动神经阻滞Ⅰ、Ⅱ级多于A组，Ⅲ级少于A组［23.9%（11/46）比6.5%（3/46）、50.0%（23/46）比41.3%（19/46）、26.1%（12/46）比52.2%（24/46）］，差异均有统计学意义（均P＜0.05）。B组麻醉5、10、30 min时心率和平均动脉压明显高于A组，差异均有统计学意义（均P＜0.05）。B组不良反应发生率明显低于A组［13.0%（6/46）比34.8%（16/46）］，差异有统计学意义（P＜0.05）。结论    0.25%浓度罗哌卡因在老年膝髋关节置换中的效果优于0.50%浓度罗哌卡因，且不良反应少。

• 【Abstract】Objective    To investigate the effect of low dose ropivacaine subarachnoid anesthesia on elderly patients undergoing knee and hip arthroplasty. Methods    A total of 92 elderly patients undergoing knee and hip arthroplasty from June 2016 to June 2017 in Guang′anmen Hospital, China Academy of Chinese Medical Sciences were randomly divided into group A and group B, with 46 cases in each group. Group A had subarachnoid injection of 0.50% ropivacaine and group B had 0.25% ropivacaine. Anesthesia duration, motor recovery time and sensory recovery time, degree of lower limb motor block, heart rate, mean arterial pressure and adverse reactions were analyzed. Results    Anesthesia duration time, motor recovery time and sensory recovery time in group B were significantly shorter than those in group A［（85±7）min vs （103±10）min, （106±11）min vs （127±14）min, （161±13）min vs （196±15）min］（P＜0.05）. Lower limb motor block grade Ⅰ and Ⅱ ratios in group B were significantly higher and grade Ⅲ ratio was significantly lower than those in group A［23.9%（11/46） vs 6.5%（3/46）, 50.0%（23/46） vs 41.3%（19/46）, 26.1%（12/46） vs 52.2%（24/46）］（P＜0.05）. Heart rate and mean arterial pressure 5, 10, 30 min after anesthesia in group B were significantly higher than those in group A（P＜0.05）. Adverse reaction rate in group B was significantly lower than that in group A［13.0%（6/46） vs 34.8%（16/46）］（P＜0.05）. Conclusion    Ropivacaine 0.25% has better anesthetic effect and less adverse reaction than 0.50% in subarachnoid anesthesia in elderly patients undergoing knee and hip arthroplasty.

  【Key words】Knee and hip arthroplasty;Ropivacaine;Subarachnoid anesthesia