目的 探讨较小剂量0.25%浓度布比卡因单侧蛛网膜下腔麻醉在高龄患者髋关节置换手术中的可行性.方法 选取2014年5月至2015年5月采用蛛网膜下腔联合硬脊膜外腔麻醉进行全髋置换的高龄患者84例,将其分为A组与B组,各42例.年龄65~90岁,ASAⅠ~Ⅲ级.两组均患侧在上,于L2~3或L3~4间隙行硬膜外穿刺,成功后置入蛛网膜下腔麻醉穿刺针,有脑脊液流出后向头端推注蛛网膜下腔麻醉药,A组给予0.25%布比卡因2.5ml,B组给予0.375%布比卡因2.5ml.后将两组麻醉前及麻醉后5min(T1)、15min(T2)、30min(T3)及出手术室时的心率(HR)、收缩压(SBP)舒张压(DBP)、脉搏血氧饱和度(SpO2)指标及运动神经阻滞评定.结果 B组注药后各时点(SBP、DBP)均比A组明显下降(P<0.05)且B组局麻药后20min运动阻滞评分与A组比较差异有统计学意义(P<0.05).结论 用0.25%轻比重布比卡因,剂量小,血流动力学平稳,用于高龄患者髋关节置换手术是可行的,值得推广.%Objective To explore the feasibility of 0.25% bupivacaine used in unilateral subarachnoid anesthesia in elderly patients with total hip arthroplasty. Methods From May 2014 to May 2015 in our hospital,the 65~90 years old patients with total hip arthroplasty used subarachnoid space combined with epidural anesthesia were divided into Group A and Group B with each group 42 cases of ASA Ⅰ~Ⅲ leve,randomly. Epidural puncture in the L2~3 or L3~4 line,after a successful placement lumbar puncture needle,push the lumbar anesthesia note with cerebrospinal fluid flow to the head end,Group A were given 0.25% bupivacaine 2.5 ml,and Group B were 0.375%.Compared the two groups,before anesthesia and anesthesia(T1), 15min(T2),30min(T3)and the operating room of heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),pulse oxygen saturation(SpO2)indexes and motor nerve block rating. Results There were significant differences in each point(SBP,DBP)and motion block rating after the local anesthetic 20 minutes(P<0.05). Conclusion Using 0.25% bupivacaine is feasible with small dose and hemodynamic stable in elderly patients with total hip arthroplasty . It is worth promoting.
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