老年膝髋关节置换应用罗哌卡因腰椎硬膜外联合麻醉:置换后不良反应率低

发布时间：2018-10-08 11:37

【摘要】：背景:老年人下肢关节手术常选用全麻或者连续硬膜外麻醉。单纯的硬膜外麻醉效果确切,容易控制,肌肉松弛效果较好,但是麻醉诱导时间相对较长,对控制膀胱腹膜反折处疼痛不理想,而且循环系统干扰受到腰麻过程中影响相对较大。目的:探讨在老年下肢骨关节置换过程中罗哌卡因腰椎硬膜外联合应用的麻醉效果。方法:纳入菏泽市立医院在2013年9月至2014年11月收治的下肢人工关节置换的老年患者90例,其中膝关节置换52例,髋关节置换38例,随机分为2组,每组45例。对照组采用连续硬膜外麻醉,观察组采用罗哌卡因腰椎硬膜外联合麻醉。观察并比较两组患者在置换过程中的生命体征、麻醉起效时间、局麻药诱导量、镇痛效果及置换后不良反应。结果与结论:置换过程中对照组患者在心率、脉搏、动脉血氧饱和度均低于观察组,观察组患者置换过程中的基本生命体征更加稳定,两组对比差异有显著性意义(P0.05)。观察组患者麻醉起效时间、局麻药诱导量明显优于对照组,两组对比差异有极显著性意义(P0.01)。对照组镇痛效果优秀率为67%,低于观察组89%,两组比较差异有显著性意义(P0.05)。对照组患者置换后出现呕吐10例、呼吸困难4例,不良反应发生率为31%;观察组出现呕吐3例,呼吸困难2例,不良反应发生率为11%,对照组不良反应发生率显著高于观察组(P0.05)。提示罗哌卡因腰椎硬膜外联合麻醉在老年下肢骨关节置换过程中镇痛效果好,麻醉起效时间短,局麻药诱导量低,置换后不良反应发生率低。
[Abstract]:Background: general anesthesia or continuous epidural anesthesia is often used in lower extremity joint surgery in the elderly. Simple epidural anesthesia is effective, easy to control, and muscle relaxation is better, but the induction time of anesthesia is relatively long, so it is not ideal to control the pain of bladder peritoneal reflex. Moreover, the circulatory system was affected by spinal anesthesia. Objective: to investigate the anesthetic effect of ropivacaine combined with lumbar epidural anesthesia in lower extremity osteoarthroplasty. Methods: from September 2013 to November 2014, 90 elderly patients with artificial joint replacement of lower extremity were enrolled in Heze City Hospital, including 52 cases of knee arthroplasty and 38 cases of hip arthroplasty, which were randomly divided into 2 groups, 45 cases in each group. The control group was treated with continuous epidural anesthesia and the observation group with ropivacaine combined epidural anesthesia. The vital signs, anaesthesia onset time, local anesthetic induction, analgesic effect and adverse reactions after replacement were observed and compared between the two groups. Results and conclusion: the heart rate, pulse and arterial oxygen saturation in the control group were lower than those in the observation group, and the basic vital signs were more stable in the observation group. The difference between the two groups was significant (P0.05). The onset time of anesthesia and the induction of local anesthetic in the observation group were significantly better than those in the control group, and the difference between the two groups was significant (P0.01). The excellent rate of analgesic effect in the control group was 67 and lower than that in the observation group 89.The difference between the two groups was significant (P0.05). There were 10 cases of vomiting and 4 cases of dyspnea in the control group, and 3 cases of vomiting and 2 cases of dyspnea in the observation group. The incidence of adverse reactions in the control group was significantly higher than that in the observation group (P0.05). It is suggested that combined epidural anesthesia with ropivacaine has a good analgesic effect during lower extremity osteoarthroplasty in the elderly, with short onset time, low induction of local anesthetics, and low incidence of adverse reactions after replacement.
【作者单位】：菏泽市立医院麻醉科;
【分类号】：R614

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