目的：探讨高龄患者下肢手术中采用丁哌卡因小剂量轻比重单侧蛛网膜下腔阻滞联合硬膜外麻醉的安全性。方法选取2013年2月～2015年2月我院就诊的高龄股骨头坏死患者75例，所有患者随机分为硬膜外组37例与腰-硬联合麻醉组38例。观察两组患者的麻醉效果，局麻药用量、痛觉恢复时间、麻醉起效时间和持续时间，Bromage等级评分及不良反应发生率。结果腰-硬联合麻醉组的优良率为97.37%，明显高于硬膜外组的89.19%，两组比较差异有统计学意义（P＜0.05）。腰-硬联合麻醉组患者的局麻药用量、痛觉恢复时间、麻醉起效时间和持续时间均明显低于硬膜外组，两组比较差异有统计学意义（P＜0.05）。两组患者Bromage等级评分显示，腰-硬联合麻醉组的麻醉效果明显优于硬膜外组，两组比较差异有统计学意义（P＜0.05）。腰-硬联合麻醉组的不良反应率为13.16%，硬膜外组为35.14%，两组比较差异有统计学意义（P＜0.05）。结论丁哌卡因小剂量轻比重单侧蛛网膜下腔阻滞联合硬膜外麻醉用于高龄患者下肢手术麻醉效果确切，可以明显降低不良反应发生率，值得临床推广应用。%ObjectiveTo explore the safety of small dose of hypobaric bupivacaine unilateral subarachnoid block combined with epidural anesthesia in elderly patients with lower limb surgery.Methods 75 patients with senile femoral head necrosis from February 2013 to February 2015 were randomly divided into epidural group of 38 cases and combined spinal epidural anesthesia group of 37 cases.The anesthesia effect,dosage of local anesthetic and pain recovery time,onset time and duration of anesthesia and Bromage grade score and adverse reaction incidence of patients of the two groups were observed and compared.ResultsThe fine rate of combined spinal epidural anesthesia group was 97.37%,significantly higher than 89.19% in the epidural group,the difference was significant between the two groups(P<0.05).The dosage of local anesthetic and pain recovery time, onset time and duration of anesthesia in combined spinal epidural anesthesia group were significantly lower than those in the epidural group, the difference was significant between the two groups(P<0.05).The bromage score of the two groups showed that the anesthesia effect of combined spinal epidural anesthesia group was significantly better than that of epidural group, and the difference between the two groups was significant (P<0.05).The adverse reaction rate of combined spinal epidural anesthesia group was 13.16%,the epidural group was 35.14%,and the difference between the two groups was significant(P<0.05). ConclusionSmall dose of hypobaric bupivacaine unilateral subarachnoid block combined with epidural anesthesia has significant anesthetic efficacy for the elderly patients with lower extremity surgery,can significantly reduce the incidence of adverse reactions,it is worthy of clinical application.
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