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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
刘莱莉,龚琴,彭健泓,余建华.轻比重与重比重布比卡因腰硬联合麻醉在老年髋关节置换术中的效果[J].中华老年多器官疾病杂志,2019,18(9):665~669
轻比重与重比重布比卡因腰硬联合麻醉在老年髋关节置换术中的效果
Efficacy of combined spinal-epidural anesthesia with light versus heavy bupivacaine in elderly patients undergoing hip replacement
投稿时间:2019-03-26  
DOI:10.11915/j.issn.1671-5403.2019.09.144
中文关键词:  布比卡因,轻比重;关节成形术,置换,髋;腰硬联合麻醉
英文关键词:bupivacaine, light specific gravity; arthroplasty, replacement, hip; combined spinal-epidural anesthesia
基金项目:
作者单位E-mail
刘莱莉 广东省佛山市中医院麻醉科,佛山 528000 iuyhvj@163.com 
龚琴 广东省佛山市中医院麻醉科,佛山 528000  
彭健泓 广东省佛山市中医院麻醉科,佛山 528000  
余建华 广东省佛山市中医院麻醉科,佛山 528000  
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中文摘要:
      目的 探究轻比重与重比重布比卡因腰硬联合麻醉在老年髋关节置换术中的应用效果。方法 选取2016年2月至2018年2月广东省佛山市中医院麻醉科收治的112例髋关节置换术老年患者作为研究对象,按照麻醉方式不同分为观察组(3ml 0.25%轻比重布比卡因腰硬联合麻醉)和对照组(3ml 0.50%重比重布比卡因腰硬联合麻醉),各组56例。比较2组患者麻醉效果,麻醉前及麻醉后5、10、15、30及60min(T1~T5)各时间点心率(HR)、平均动脉压(MAP)与动脉血氧饱和度(SpO2)水平,下肢运动阻滞程度(采用改良Bromage法评价)以及不良反应等情况。采用SPSS 17.0统计软件分析数据。结果 与对照组比较,观察组患者麻醉维持时间显著升高[(123.3±10.5)和(110.2±10.3)s,P=0.031],感觉阻滞起效时间[(35.6±7.4)和(45.7±7.9)s,P=0.008]及运动阻滞起效时间[(235.7±34.7)和(270.7±39.7)s,P=0.041]显著降低,差异有统计学意义。在T0~T3各时间点,2组患者HR比较差异不显著(P>0.05),但T4~T5时间点观察组HR显著低于对照组(P<0.05)。在T0~T5各时间点,2组患者MAP比较差异无统计学意义(P>0.05)。在T1~T4时间点观察组患者SpO2显著高于对照组(P<0.05)。观察组HR、MAP、SpO2在T0~T5不同时间点水平略有不同,但差异无统计学意义(P>0.05)。与T0比较,对照组患者T1~T5的HR及T2~T5的MAP发生显著变化,差异有统计学意义(P>0.05)。与术前相比,术后观察组(P=0.013)及对照组(P=0.015)Bromage 2级比例均显著升高,3级比例(P=0.038;P=0.021)显著下降。同时术后观察组1级(P=0.021)、2级(P=0.039)比例显著高于对照组,差异有统计学意义。轻比重与对照组患者不良反应总发生率比较差异有统计学意义[8.9%(5/56)和37.5%(21/56);P=0.000]。结论 在老年髋关节置换术中采用轻比重布比卡因腰硬联合麻醉效果显著,可降低术中血流动力学波动,减少并发症发生,可靠性及安全性较高。
英文摘要:
      Objective To explore the efficay of combined spinal-epidural anesthesia with light and heavy bupivacaine in the elderly undergoing hip replacement. Methods A total of 112 elderly patients undergoing hip replacement in our hospital from February 2016 to February 2018 were subjected in this study. According to the types of anesthesia, they were divided into observation group (3ml 0.25% light specific gravity bupivacaine combined spinal-epidural anesthesia) and control group (3 ml 0.50% heavy specific gravity bupivacaine combined spinal-epidural anesthesia), with 56 cases in each group. The anesthetic effect, heart rate (HR), mean arterial pressure (MAP), and arterial oxygen saturation (SpO2) before and 5,0, 15,0 and 60min after anesthesia (T1-T5), and severity of lower extremity motor block (assessed by modified Bromage scale) and adverse events were compared between the 2 groups. SPSS statistics 17.0 was used to analyze the data. Results Compared with the control group, the observation group had significantly longer duration of anesthesia maintenance [(123.3±10.5) vs (110.2±10.3)s, P=0.031], while shorter onset times of sensory block [(35.6±7.4) vs (45.7±7.9)s, P=0.008] and of motor block [(235.7±34.7) vs (270.7±39.7)s, P=0.041]. There was no significant difference in HR between the 2 groups at T0-T3 (P>0.05), but HR was significantly lower in the observation group than the control group at T4-T5 (P<0.05). No significant difference was seen in [JP+1]MAP between the 2 groups at T0-T5 (P>0.05).SpO2 in the observation group was significantly higher than that in the control group at T1-T4 time points (P<0.05). HR, MAP and SpO2 levels in the observation group were slightly different at different time points from T0 to T5, but without significant differences (P>0.05). Compared with T0, HR of T1-T5 and MAP of T2-T5 in the control group changed significantly (P>0.05). Compared with pre-operation, the proportion of Bromage grade 2 in the observation group (P=0.013) and the control group (P=0.015) was increased significantly, while the proportion of grade 3 (P=0.038; P=0.021) was decreased significantly. At the same time, the proportion of grade 1 (P=0.021) and grade 2 (P=0.039) in the observation group was significantly higher than that in the control group. There was a significant difference in the incidence of adverse reactions between the 2 groups [8.9%(5/56) vs 37.5%(21/56); P=0.000]. Conclusion Light specific gravity bupivacaine combined with spinal epidural anesthesia is superior to heavy specific gravity bupivacaine in elderly patients undergoing hip replacement, because of its reducing intraoperative hemodynamic fluctuations and the occurrence of adverse events, and of high reliability and safety.
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