本文選題：輕比重 + 羅哌卡因��； 參考：《中國老年學(xué)雜志》2017年08期

【摘要】：目的探討輕比重不同濃度羅哌卡因單側(cè)腰-硬聯(lián)合麻醉對高齡髖關(guān)節(jié)置換術(shù)患者鎮(zhèn)痛效果及血流動(dòng)力學(xué)的影響。方法擇期行單側(cè)髖關(guān)節(jié)置換術(shù)患者106例隨機(jī)單盲取法分為A、B、C 3組,A組35例給予輕比重0.2%羅哌卡因,B組35例給予輕比重0.3%羅哌卡因,C組36例給予輕比重0.5%羅哌卡因;均進(jìn)行腰-硬聯(lián)合麻醉,觀察入室時(shí)(T0)、穿刺前(T1)、切開皮膚時(shí)間(T2)、T2后15 min(T3)、T2后30 min(T4)、縫合完成時(shí)(T5)各時(shí)間點(diǎn)血流動(dòng)力學(xué)指標(biāo)脈壓差(MAP)、心率(HR)、呼吸頻率(RR)及血氧飽和度(Sp O2)變化。同時(shí)觀察術(shù)中不良反應(yīng)、感覺及運(yùn)動(dòng)阻滯見效、恢復(fù)時(shí)間、阻滯12、24、48、72 h 4個(gè)時(shí)間點(diǎn)視覺模擬評分法(VAS)評定鎮(zhèn)痛效果。結(jié)果 A組T1~T5各時(shí)間點(diǎn)MAP、HR、RR均顯著低于同組T0(P0.05),B組T1~T5時(shí)間點(diǎn)MAP、HR、RR低于同組T1及A組同指標(biāo)同時(shí)間點(diǎn)(P0.05),C組T1~T5時(shí)間點(diǎn)MAP、HR、RR顯著低于同組T1及A、B組同指標(biāo)同時(shí)間點(diǎn)(P0.05),3組不同時(shí)間點(diǎn)Sp O2差異無統(tǒng)計(jì)學(xué)意義(P0.05)。B、C組被動(dòng)運(yùn)動(dòng)及主動(dòng)運(yùn)動(dòng)VAS評分顯著低于A組(P0.05),B、C組同指標(biāo)VAS評分差異無統(tǒng)計(jì)學(xué)意義(P0.05)。B、C組運(yùn)動(dòng)阻滯見效時(shí)間顯著低于A組(P0.05),感覺及運(yùn)動(dòng)恢復(fù)時(shí)間均顯著高于A組(P0.05),C組不良反應(yīng)總發(fā)生率(41.66%)明顯高于B組(17.14%)、A組(8.57%)(P0.05),A組與B組總發(fā)生率差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論輕比重0.3%羅哌卡因單側(cè)腰-硬聯(lián)合麻醉可滿足高齡髖關(guān)節(jié)置換術(shù)要求,鎮(zhèn)痛效果完善,對血流動(dòng)力學(xué)影響小,不良反應(yīng)少。
[Abstract]:Objective to investigate the analgesic effect and hemodynamics of different concentrations of ropivacaine in patients undergoing hip arthroplasty. Methods 106 patients undergoing unilateral hip arthroplasty were randomly divided into group A (n = 35) and group A (n = 35) given light weight 0.2% ropivacaine group B (n = 35) with light specific gravity of 0.3% ropivacaine and group C (n = 36) with light weight of 0.5% ropivacaine. Combined spinal-epidural anesthesia was performed to observe the changes of T _ 0, T _ 1, T _ 2, T _ 3 and T _ 4 T _ 4 at 15 min after T _ 2 and T _ 2 T _ 2, and T _ 5) at different time points, such as HRR, respiratory frequency (RRR) and oxygen saturation (Sp / O _ 2) at each time point. The hemodynamic indexes of T _ (5) were as follows: pulse pressure difference (map), heart rate (HRM), respiratory frequency (RR) and blood oxygen saturation (Sp / O _ 2). At the same time, adverse reactions, sensory and motor block, recovery time and visual analogue score at 4 time points of 12: 24 and 48 ~ 72 h were observed to evaluate the analgesic effect. Results the T1~T5 HR-HRRR at each time point in group A was significantly lower than that in group T _ 0, P _ (0.05) and B was significantly lower than that in group T _ 1 and group A at the same time point (P 0.05) and that in group C was significantly lower than that in group T _ (1) and group A (B) at the same time point (P0.05). There was no significant difference in SPO 2. The VAS score of passive and active movement in group P0.05C was significantly lower than that in group A (P 0.05). There was no significant difference in VAS score between group C and group A (P 0.05). The effective time of motor block in group C was significantly lower than that in group A (P 0.05), and the sensory and motor recovery was significantly lower than that in group A (P 0.05). The total incidence of adverse reactions in group A was significantly higher than that in group A (P 0.05) and the total incidence of adverse reactions in group C was significantly higher than that in group B (P = 17.14). There was no significant difference in the total incidence rate between group A and group B (P 0.05). Conclusion combined spinal-epidural anesthesia with 0.3% ropivacaine can meet the requirements of hip arthroplasty in elderly patients. The analgesic effect is perfect, the hemodynamic effect is small and the adverse reaction is less.
【作者單位】： 宜賓市第一人民醫(yī)院麻醉科;
【分類號】：R614

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