發(fā)布時間：2018-01-24 19:22

  本文關(guān)鍵詞： 蛛網(wǎng)膜下腔 布比卡因注射液 年齡 濃度 運動神經(jīng)阻滯　出處：《武漢大學(xué)》2015年博士論文　論文類型：學(xué)位論文

【摘要】：目的：1、探討在成年人(18-83歲)蛛網(wǎng)膜下腔麻醉中布比卡因運動神經(jīng)阻滯的半數(shù)有效劑量(ED5o),評估年齡對運動神經(jīng)阻滯ED5o的影響。2、探討在年輕組和老年組中局麻藥濃度對布比卡因運動神經(jīng)阻滯的ED5o的影響。方法：選擇需要蛛網(wǎng)膜下腔麻醉且無此麻醉禁忌癥的非孕成年患者233人,分為三個不同部分來研究。1、年齡對布比卡因運動神經(jīng)阻滯的半數(shù)有效劑量的影響選擇129名患者,根據(jù)年齡分成6組(20-30歲；31-40歲；41-50歲；51-60歲；61-70歲；71-80歲),每組的第一例患者都選擇0.75%布比卡因7.5mg,并根據(jù)前一例運動神經(jīng)阻滯的效果調(diào)整后一例布比卡因的劑量,每次的增加或減少的劑量為0.75mg。運動神經(jīng)阻滯的判定方法是根據(jù)注射完后5分鐘以內(nèi)任何一個下肢的運動評分,評分標(biāo)準(zhǔn)根據(jù)Bromage評分和髖部運動功能評分。ED5o運用Dixon和Massey方法和邏輯回歸方法測算出。同時記錄無創(chuàng)血壓和心率、最高的麻醉平面和運動阻滯持續(xù)時間。2、布比卡因濃度對年輕患者運動神經(jīng)阻滯的半數(shù)有效劑量的影響選擇40名年輕患者(18-40歲),根據(jù)布比卡因濃度分成兩組(0.75%；0.375%),麻醉藥的濃度都選擇0.75%布比卡因,根據(jù)需要增加一倍的生理鹽水配備成0.375%布比卡因溶液。余試驗方法同1。3、布比卡因濃度對老年患者運動神經(jīng)阻滯的半數(shù)有效劑量的影響選擇64名老年患者(≥70歲),根據(jù)布比卡因濃度分成三組(0.75%；0.375%；0.25%),麻醉藥的濃度都選擇0.75%布比卡因,根據(jù)需要增加一倍或兩倍的生理鹽水配備成0.375%或0.25%布比卡因溶液。余試驗方法同1。結(jié)果：1、年齡對布比卡因運動神經(jīng)阻滯的半數(shù)有效劑量的影響蛛網(wǎng)膜下腔布比卡因運動神經(jīng)阻滯的ED5o值在20-30歲為10.22 mg(95%CI: 9.96-10.49 mg),在31-40歲為9.52 mg (95%CI:9.02-10.07 mg),在41-50歲為8.37 mg (95%CI:7.56-9.26 mg),在51-60歲為7.30 mg (95%CI:6.84-7.79 mg),在61-70歲為6.55 mg (95%CI:6.01-7.13 mg),在71-80歲為5.78 mg (95%CI: 5.01-6.67 mg) 。六組中最大感覺阻滯平面在5分鐘時是L1-L2,10分鐘時是T10-L1。各組中運動神經(jīng)阻滯的持續(xù)時間存在差異(P0.05)。2、布比卡因濃度對年輕患者運動神經(jīng)阻滯的半數(shù)有效劑量的影響0.75%布比卡因組和0.375%布比卡因組蛛網(wǎng)膜下腔布比卡因運動神經(jīng)阻滯的ED50值分別為9.998mg和8.890 mg。3、布比卡因濃度對老年患者運動神經(jīng)阻滯的半數(shù)有效劑量的影響0.75%布比卡因組、0.375%布比卡因組和0.25%布比卡因組蛛網(wǎng)膜下腔布比卡因運動神經(jīng)阻滯的ED50值分別為6.10 mg (95%CI:5.68,6.55 mg)、6.04 mg (95%CI:5.76,6.33 mg)和5.43 mg (95%CI:5.16,5.71 mg)。結(jié)論：蛛網(wǎng)膜下腔布比卡因運動神經(jīng)阻滯的ED50值隨著年齡的增加而逐漸減少。布比卡因濃度對不同年齡患者運動神經(jīng)阻滯的ED50的影響是一致的,不論在年輕患者還是老年患者,隨著布比卡因濃度的降低,其相對應(yīng)的ED50值也會逐漸降低。
[Abstract]:Objective to investigate the median effective dose of bupivacaine motor nerve block during subarachnoid anesthesia in adults aged 18-83 years. To evaluate the effect of age on motor nerve block (ED5o). Objective: to investigate the effect of local anesthetic concentration on ED5o of bupivacaine motor nerve block in young group and senile group. Methods: 233 non-pregnant adult patients who needed subarachnoid anesthesia and did not have this contraindication were selected. The effect of age on the half effective dose of bupivacaine motor nerve block was studied in three different parts. 129 patients were divided into 6 groups according to their age. 31-40 years of age; 41-50 years; 51-60 years; 61-70 years; The first patients in each group were given 0.75% bupivacaine 7.5 mg and the dose of bupivacaine was adjusted according to the effect of motor nerve block. The increased or decreased dose was 0.75 mg per time. Motor nerve block was judged by motor score of any lower extremity within 5 minutes after injection. The score was calculated according to Bromage score and hip motor function score. ED5o was measured by Dixon and Massey methods and logical regression method. Noninvasive blood pressure and heart rate were recorded at the same time. Effects of bupivacaine concentration on the median effective dose of motor nerve block in young patients 40 young patients aged 18-40 years were selected. According to the concentration of bupivacaine, the rats were divided into two groups. 0.75% bupivacaine was selected for the concentration of the anesthetic, and the physiological saline was doubled to 0.375% bupivacaine solution according to the need. The remaining test methods were the same as 1.3. Effect of bupivacaine concentration on half effective dose of motor nerve block in elderly patients 64 elderly patients (鈮，

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