轻比重腰麻在老年骨科手术中的应用(1)
[摘要]目的 探討轻比重腰麻在老年骨科手术中的应用。方法 选择2018年1～10月在江西省吉安市第一人民医院治疗的60例下肢骨科手术患者作为研究对象，将其随机分为观察组与对照组，每组各30例。观察组患者采用轻比重罗哌卡因麻醉，对照组患者采用重比重罗哌卡因麻醉。比较两组患者的感觉阻滞起效时间、平面固定时间、感觉阻滞持续时间、运动阻滞起效时间、最大运动阻滞时间、最大Bromage评分，麻醉前、麻醉后10、30 min及手术结束后心率(HR)、收缩压(SBP)、舒张压(DBP)及麻醉效果。结果 观察组患者的感觉阻滞起效时间、平面固定时间、运动阻滞起效时间、最大运动阻滞时间均显著长于对照组，差异有统计学意义(P<0.05)；观察组患者的最大Bromage评分显著低于对照组，差异有统计学意义(P<0.05)；两组患者的感觉阻滞持续时间比较，差异无统计学意义(P<0.05)。两组患者麻醉前的HR、血压比较，差异无统计学意义(P>0.05)；观察组患者麻醉后10、30 min以及手术结束后的HR、SBP、DBP与麻醉前比较，差异无统计学意义(P>0.05)；对照组患者手术结束后的HR、SBP、DBP与麻醉前比较，差异无统计学意义(P>0.05)；对照组患者麻醉后10、30 min的HR、SBP、DBP均显著低于麻醉前，差异有统计学意义(P<0.05)；观察组患者麻醉后10、30 min的HR、SBP、DBP均显著高于对照组，差异有统计学意义(P<0.05)。两组患者的麻醉优良率比较，差异无统计学意义(P>0.05)。结论 轻比重腰麻用于老年骨科手术，虽然麻醉起效时间相对延迟，但两组的麻醉效果相似，且轻比重对老年患者血压、HR的影响小，安全性更高。
[关键词]轻比重；腰麻；老年；骨科
[中图分类号] R614.1 [文献标识码] A [文章编号] 1674-4721(2019)4(c)-0102-04
Application of light specific gravity spinal anesthesia in geriatric orthopedics operation
XIE Ai-rong1 ZHANG Ming-sheng2 LI Ya-lan1 CHENG Xing-hua1 WANG Qiong-qiong1
1. Department of Anesthesiology， the First People′s Hospital of Ji′an City， Jiangxi Province， Ji′an 343000， China； 2. Department of Anesthesiology， Jiangxi Provincial People′s Hospital， Nanchang 330006， China
[Abstract] Objective To discuss the application of light specific gravity spinal anesthesia in geriatric orthopedics operation. Methods Sixty cases of patients with lower limb orthopaedic surgery treated in the First People′s Hospital of Ji′an City from January to October 2018 were selected as the research objects and they were randomly divided into observation group and control group， with 30 cases in each group. The observation group was anesthetized with light specific gravity Ropivacaine， and the control group was anesthetized with heavy specific gravity Ropivacaine. The sensory block onset time， plane fixation time， sensory block duration， motor block onset time， maximum motor block time， and maximum Bromage score， heart rate (HR)， systolic blood pressure (SBP)， diastolic blood pressure (DBP) before anesthesia， 10， 30 min after anesthesia， and after operation and anesthetic effect were compared between the two groups. Results The sensory block onset time， plane fixation time， motor block onset time， and maximum motor block time in the observation group were significantly longer than those in the control group， and the differences were statistically significant (P<0.05). The maximum Bromage score of the observation group was significantly lower than that of the control group， and the difference was statistically significant (P<0.05). There was no significant difference in the duration of sensory block between the two groups (P<0.05). There were no significant differences in HR and blood pressure between the two groups before anesthesia (P>0.05). There were no significant differences in HR， SBP and DBP in the observation group between 10， 30 min after anesthesia， after operation and before anesthesia (P>0.05). There were no significant differences in HR， SBP and DBP in the control group between before anesthesia and after operation (P>0.05). The HR， SBP and DBP of the control group at 10 and 30 min after anesthesia were significantly lower than those before anesthesia， and the differences were statistically significant (P<0.05). The HR， SBP and DBP of the observation group were significantly higher than those of the control group at 10 and 30 min after anesthesia， and the differences were statistically significant (P<0.05). There was no significant difference in the excellent rate of anesthesia between the two groups (P>0.05). Conclusion Light specific gravity lumbar anesthesia is used in geriatric orthopaedic surgery， although the onset time of anesthesia is later than that of heavy specific gravity lumbar anesthesia， but the two groups have similar anesthetic effect. Moreover， light specific gravity has little effect on blood pressure and HR in geriatric patients， and the safety is higher., 百拇医药(谢爱荣 张明生 李亚兰)
[关键词]轻比重；腰麻；老年；骨科
[中图分类号] R614.1 [文献标识码] A [文章编号] 1674-4721(2019)4(c)-0102-04
Application of light specific gravity spinal anesthesia in geriatric orthopedics operation
XIE Ai-rong1 ZHANG Ming-sheng2 LI Ya-lan1 CHENG Xing-hua1 WANG Qiong-qiong1
1. Department of Anesthesiology， the First People′s Hospital of Ji′an City， Jiangxi Province， Ji′an 343000， China； 2. Department of Anesthesiology， Jiangxi Provincial People′s Hospital， Nanchang 330006， China
[Abstract] Objective To discuss the application of light specific gravity spinal anesthesia in geriatric orthopedics operation. Methods Sixty cases of patients with lower limb orthopaedic surgery treated in the First People′s Hospital of Ji′an City from January to October 2018 were selected as the research objects and they were randomly divided into observation group and control group， with 30 cases in each group. The observation group was anesthetized with light specific gravity Ropivacaine， and the control group was anesthetized with heavy specific gravity Ropivacaine. The sensory block onset time， plane fixation time， sensory block duration， motor block onset time， maximum motor block time， and maximum Bromage score， heart rate (HR)， systolic blood pressure (SBP)， diastolic blood pressure (DBP) before anesthesia， 10， 30 min after anesthesia， and after operation and anesthetic effect were compared between the two groups. Results The sensory block onset time， plane fixation time， motor block onset time， and maximum motor block time in the observation group were significantly longer than those in the control group， and the differences were statistically significant (P<0.05). The maximum Bromage score of the observation group was significantly lower than that of the control group， and the difference was statistically significant (P<0.05). There was no significant difference in the duration of sensory block between the two groups (P<0.05). There were no significant differences in HR and blood pressure between the two groups before anesthesia (P>0.05). There were no significant differences in HR， SBP and DBP in the observation group between 10， 30 min after anesthesia， after operation and before anesthesia (P>0.05). There were no significant differences in HR， SBP and DBP in the control group between before anesthesia and after operation (P>0.05). The HR， SBP and DBP of the control group at 10 and 30 min after anesthesia were significantly lower than those before anesthesia， and the differences were statistically significant (P<0.05). The HR， SBP and DBP of the observation group were significantly higher than those of the control group at 10 and 30 min after anesthesia， and the differences were statistically significant (P<0.05). There was no significant difference in the excellent rate of anesthesia between the two groups (P>0.05). Conclusion Light specific gravity lumbar anesthesia is used in geriatric orthopaedic surgery， although the onset time of anesthesia is later than that of heavy specific gravity lumbar anesthesia， but the two groups have similar anesthetic effect. Moreover， light specific gravity has little effect on blood pressure and HR in geriatric patients， and the safety is higher., 百拇医药(谢爱荣 张明生 李亚兰)