小剂量布比卡因蛛网膜下腔麻醉联合脊椎麻醉联动快速补液在高龄患者下肢手术中的应用

Small-dose Bupivacaine spinal anesthesia combined with rapid infusion for lower limb surgery in elderly patients

摘要:

目的  观察高龄患者蛛网膜下腔麻醉联合脊椎麻醉（简称腰麻）时采用小剂量、分次及控速推注布比卡因联动快速补液的临床效果。方法  择期行单侧下肢手术的患者90例，年龄80～101岁，ASA分级在Ⅱ～Ⅳ级，随机分为对照组：单次推药布比卡因6～8 mg（A组）；观察组：分次小剂量组4～6 mg，首次推药布比卡因4mg（B组）；首次推药布比卡因2 mg（C组）。３组腰麻用药后即刻启动快速补液（15 ml/kg，20 min内输完）。观察腰麻用药前和用药后20 min内不同时点的血液动力学变化，记录布比卡因的用量及麻黄碱例数等相关数据。结果  用药后T1～T5时３组SBP和DBP明显低于T0时（P <0.05），其中，T3时A组SBP和DBP明显低于B和C组（P <0.05）；３组间HR在T3时点A组明显高于B和C组（P <0.05）；A组有6例需用麻黄碱干扰，而B和C组无麻黄碱干扰（P <0.05）。结论  小剂量、分次及慢速推注布比卡因调控单侧腰麻的同时联动快速补液对高龄患者手术腰麻后血液动力学稳定性好，能优化高龄患者手术腰麻方案。

Abstract:

Objective To investigate the clinical effects of small-dose Bupivacaine spinal anesthesia combined with rapid infusion in elderly patients undergoing lower limb operation. Methods Ninety cases of elderly patients aged 80 to 101 years between ASA Ⅱ and Ⅳ grade were randomly divided into three groups: control group (group A) and observation groups (groups B and C) with 30 in each group. The group A received a single bolus of Bupivacaine (6-8 mg), whereas the groups B and C received small dose of Bupivacaine (4-6 mg). All patients were given rapid fluid infusion (15 ml/kg) after spinal anesthesia. BP, HR and SPO2 at different time points, the dose of Bupivacaine and the number of cases using Ephedrine were recorded in all the three groups. Results In all the three groups,  SBP and DBP were significantly lower at T1-T5 than those at T0 (P < 0.05); SBP and DBP at T3 were significantly lower in the group A than those in the groups B and C (P < 0.05). HR at T3 was higher in the group A than in the groups B and C (P < 0.05). The doses of Bupivacaine and Ephedrine were smaller in the groups B and C than in the group A (P < 0.05). Conclusions Small-dose Bupivacaine spinal anesthesia combined with rapid infusion can be used as a safe anesthesia in elderly patients undergoing lower limb surgery.