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| 不同剂量布比卡因蛛网膜下腔阻滞对老年患者髋部手术低血压的影响 |
| Effect of different doses of bupivacaine subarachnoid block on hypotension in elderly patients undergoing hip surgery |
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| DOI：10.12089/jca.2023.03.007 |
| 中文关键词: 老年 髋部手术 布比卡因 低血压 血流动力学 |
| 英文关键词: Aged Hip surgery Bupivacaine Hypotension Hemodynamics |
| 基金项目:延安市基于ERAS下的临床麻醉管理科技创新团队项目（2021-21） |
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| 中文摘要: |
目的 观察脑脊液稀释不同剂量布比卡因蛛网膜下腔阻滞对老年患者髋部手术低血压的影响。
方法 选择2020年12月至2022年2月拟在腰-硬联合麻醉下行髋部手术的患者137例，男45例，女92例，年龄75～100岁，BMI 13～32 kg/m 2，ASA Ⅱ 或 Ⅲ 级。根据不同布比卡因用量，随机分为四组：布比卡因 3.75 mg组（B1组，n=33）、布比卡因5.0 mg组（B2组，n=34）、布比卡因7.5 mg组（B3组，n=35）和布比卡因10.0 mg组（B4组，n=35）。四组患者于L2-3或L3-4实施腰-硬联合麻醉，以0.1 ml/s的速度B1组注入蛛网膜下腔0.1875 %布比卡因3.75 mg，B2组注入0.25%布比卡因5.0 mg，B3组注入0.375%布比卡因7.5 mg，B4组注入0.5%布比卡因10.0 mg。记录患者改良虚弱指数（mFI），手术时间、手术类型、术中净入量，术中低血压总体发生率、早期低血压发生率，上升至最高阻滞平面时间、阻滞节段数、感觉神经阻滞持续时间、硬膜外用药率、单侧阻滞率。
结果 B1组和B2组术中低血压总体发生率和早期低血压发生率明显低于B3组和B4组（P＜0.05）。B2组和B3组上升至最高阻滞平面时间和感觉神经阻滞持续时间明显短于B4组（P＜0.05）。B1组感觉神经阻滞持续时间明显短于B2组、B3组和B4组（P＜0.05）。B1组硬膜外用药率明显高于B2组、B3组和B4组（P＜0.05），B2组明显高于B4组（P＜0.05）。B1组和B2组单侧阻滞率明显高于B3组和B4组（P＜0.05）。
结论 脑脊液稀释0.25%布比卡因5.0 mg蛛网膜下腔阻滞用于老年髋部手术患者，术中低血压发生率低，单侧肢体阻滞率高，无需侧卧等待，缩短了切皮时间，麻醉后血流动力学平稳，更利于老年患者髋部手术蛛网膜下腔阻滞。 |
| 英文摘要: |
Ojective To observe the effect of different doses of bupivacaine subarachnoid block diluted with cerebrospinal fluid on hemodynamic stability in elderly patients undergoing hip surgery.
Methods A total of 137 patients with hip surgery under combined spinal-epidural anesthesia from December 2020 to February 2022 were selected, there were 45 males and 92 females, aged 75-100 years, BMI 13-32 kg/m 2, ASA physical status Ⅱ or Ⅲ. According to the dosage of bupivacaine, the patients were randomly divided into four groups: bupivacaine 3.75 mg group (group B1, n = 33), bupivacaine 5.0 mg group (group B2, n = 34), bupivacaine 7.5 mg group (group B3, n = 35) and bupivacaine 10.0 mg group (group B4, n = 35). The four groups were given combined lumbo-epidural anesthesia at L2-3 or L3-4. The subarachnoid space was injected with 0.1875% bupivacaine 3.75 mg in group B1, 0.25% bupivacaine 5.0 mg in group B2, 0.375% bupivacaine 7.5 mg in group B3, 0.5% bupivacaine 10.0 mg in group B4 at a rate of 0.1 ml/s. The patients' modified frailty index (mFI), operation time, operation type, intraoperative net intake, overall incidence of intraoperative hypotension, incidence of early hypotension, the time to rise to the highest plane level, number of block segments, duration of sensory nerve block, epidural medication rate, and unilateral block rate were recorded.
Results The overall incidence of intraoperative hypotension and the early incidence of intraoperative hypotension in groups B1 and B2 were significantly lower than those in groups B3 and B4 (P < 0.05). The time to rise to the highest block plane and the duration of sensory nerve block in groups B2 and B3 were significantly shorter than those in group B4 (P < 0.05). The duration of sensory nerve block in group B1 was significantly shorter than that in groups B2, B3 and B4 (P < 0.05). The rate of epidural drug use in group B1 was significantly higher than that in groups B2, B3 and B4 (P < 0.05), and that in group B2 was significantly higher than that in group B4 (P < 0.05). The unilateral block rate in groups B1 and B2 was significantly higher than that in groups B3 and B4 (P < 0.05).
Conclusion Cerebrospinal fluid dilution of 0.25% bupivacaine 5.0 mg subarachnoid block is used in elderly hip surgery patients, with a low incidence of intraoperative hypotension and a high unilateral limb block rate, no need to wait at side-lying position, shortening thetime for cutting skin, stable hemodynamics after anesthesia, which is more conducive to the subarachnoid block of hip surgery in the elderly. |
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