轻比重不同浓度罗哌卡因单侧腰-硬联合麻醉对高龄髋关节置换术患者镇痛效果及血流动力学的影响

发布时间：2018-05-13 12:30

本文选题：轻比重 + 罗哌卡因　；参考：《中国老年学杂志》2017年08期

【摘要】：目的探讨轻比重不同浓度罗哌卡因单侧腰-硬联合麻醉对高龄髋关节置换术患者镇痛效果及血流动力学的影响。方法择期行单侧髋关节置换术患者106例随机单盲取法分为A、B、C 3组,A组35例给予轻比重0.2%罗哌卡因,B组35例给予轻比重0.3%罗哌卡因,C组36例给予轻比重0.5%罗哌卡因;均进行腰-硬联合麻醉,观察入室时(T0)、穿刺前(T1)、切开皮肤时间(T2)、T2后15 min(T3)、T2后30 min(T4)、缝合完成时(T5)各时间点血流动力学指标脉压差(MAP)、心率(HR)、呼吸频率(RR)及血氧饱和度(Sp O2)变化。同时观察术中不良反应、感觉及运动阻滞见效、恢复时间、阻滞12、24、48、72 h 4个时间点视觉模拟评分法(VAS)评定镇痛效果。结果 A组T1~T5各时间点MAP、HR、RR均显著低于同组T0(P0.05),B组T1~T5时间点MAP、HR、RR低于同组T1及A组同指标同时间点(P0.05),C组T1~T5时间点MAP、HR、RR显著低于同组T1及A、B组同指标同时间点(P0.05),3组不同时间点Sp O2差异无统计学意义(P0.05)。B、C组被动运动及主动运动VAS评分显著低于A组(P0.05),B、C组同指标VAS评分差异无统计学意义(P0.05)。B、C组运动阻滞见效时间显著低于A组(P0.05),感觉及运动恢复时间均显著高于A组(P0.05),C组不良反应总发生率(41.66%)明显高于B组(17.14%)、A组(8.57%)(P0.05),A组与B组总发生率差异无统计学意义(P0.05)。结论轻比重0.3%罗哌卡因单侧腰-硬联合麻醉可满足高龄髋关节置换术要求,镇痛效果完善,对血流动力学影响小,不良反应少。
[Abstract]:Objective to investigate the analgesic effect and hemodynamics of different concentrations of ropivacaine in patients undergoing hip arthroplasty. Methods 106 patients undergoing unilateral hip arthroplasty were randomly divided into group A (n = 35) and group A (n = 35) given light weight 0.2% ropivacaine group B (n = 35) with light specific gravity of 0.3% ropivacaine and group C (n = 36) with light weight of 0.5% ropivacaine. Combined spinal-epidural anesthesia was performed to observe the changes of T _ 0, T _ 1, T _ 2, T _ 3 and T _ 4 T _ 4 at 15 min after T _ 2 and T _ 2 T _ 2, and T _ 5) at different time points, such as HRR, respiratory frequency (RRR) and oxygen saturation (Sp / O _ 2) at each time point. The hemodynamic indexes of T _ (5) were as follows: pulse pressure difference (map), heart rate (HRM), respiratory frequency (RR) and blood oxygen saturation (Sp / O _ 2). At the same time, adverse reactions, sensory and motor block, recovery time and visual analogue score at 4 time points of 12: 24 and 48 ~ 72 h were observed to evaluate the analgesic effect. Results the T1~T5 HR-HRRR at each time point in group A was significantly lower than that in group T _ 0, P _ (0.05) and B was significantly lower than that in group T _ 1 and group A at the same time point (P 0.05) and that in group C was significantly lower than that in group T _ (1) and group A (B) at the same time point (P0.05). There was no significant difference in SPO 2. The VAS score of passive and active movement in group P0.05C was significantly lower than that in group A (P 0.05). There was no significant difference in VAS score between group C and group A (P 0.05). The effective time of motor block in group C was significantly lower than that in group A (P 0.05), and the sensory and motor recovery was significantly lower than that in group A (P 0.05). The total incidence of adverse reactions in group A was significantly higher than that in group A (P 0.05) and the total incidence of adverse reactions in group C was significantly higher than that in group B (P = 17.14). There was no significant difference in the total incidence rate between group A and group B (P 0.05). Conclusion combined spinal-epidural anesthesia with 0.3% ropivacaine can meet the requirements of hip arthroplasty in elderly patients. The analgesic effect is perfect, the hemodynamic effect is small and the adverse reaction is less.
【作者单位】：宜宾市第一人民医院麻醉科;
【分类号】：R614

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