中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (9): 1227-1233.doi: 10.3969/j.issn.2095-4344.2016.09.002

• 人工假体 artificial prosthesis • 上一篇    下一篇

老年下肢关节置换及植入物内固定治疗中应用罗哌卡因腰椎及硬膜外联合麻醉的优势

李友安1，吴 勇2   

  1. 1西藏民族大学附属医院麻醉科，陕西省咸阳市 712082；2广州医科大学附属第二医院骨科，广东省广州市 510260
  • 收稿日期:2015-12-08 出版日期:2016-02-19 发布日期:2016-02-19
  • 通讯作者: 李友安，西藏民族大学附属医院麻醉科，陕西省咸阳市 712082
  • 作者简介:李友安，男，1964年生，陕西省安康市人，2011年延安大学医学院毕业，副主任医师。
  • 基金资助:
    广州市属高校科研计划项目(2014D112)  

Advantages of lumbar epidural anesthesia with ropivacaine in elderly lower limb joint replacement and implant fixation

Li You-an1, Wu Yong2   

  1. 1Department of Anesthesiology, Affiliated Hospital of Xizang Minzu University, Xianyang 712082, Shaanxi Province, China; 2Department of Orthopedics, Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, Guangdong Province, China
  • Received:2015-12-08 Online:2016-02-19 Published:2016-02-19
  • Contact: Li You-an, Department of Anesthesiology, Affiliated Hospital of Xizang Minzu University, Xianyang 712082, Shaanxi Province, China
  • About author:Li You-an, Associate chief physician, Department of Anesthesiology, Affiliated Hospital of Xizang Minzu University, Xianyang 712082, Shaanxi Province, China
  • Supported by:

    the Guangzhou Municipal University Science Research Project, No. 2014D112

PDF

398

被引次数

14

摘要：

文章快速阅读：

文题释义：

罗哌卡因：是单一对映结构体(S形)长效酰胺类局麻药，其作用机制为抑制神经细胞钠离子通道，阻断神经兴奋与传导。对运动神经的阻滞作用与药物浓度有关，体积分数为0.2%时对感觉神经阻滞较好，但几乎无运动神经阻滞效果作用；体积分数为0.75%时则产生较好的运动神经阻滞作用。

硬膜外间隙阻滞麻醉：即将局麻药注入硬膜外腔阻滞脊神经根，暂时使其支配区域产生麻痹，称为硬膜外间隙阻滞麻醉，简称为硬膜外阻滞。 

 

背景：老年患者由于自身伴有多种疾病，再加上体质及代偿能力差，导致在进行髋关节置换及植入物内固定治疗时对于麻醉要求较高。罗哌卡因腰椎硬膜外联合麻醉是目前临床上使用较多的麻醉镇痛方法，但是该麻醉方法在老年髋关节置换及植入物内固定治疗中研究较少。
目的：探讨老年髋关节置换及植入物内固定治疗中应用罗哌卡因腰椎硬膜外联合麻醉的效果。
方法：选取西藏民族大学附属医院骨科2014年2月至2015年8月诊治的50例老年髋关节置换及植入物内固定患者资料进行分析，将患者50例随机分为连续硬膜外麻醉组和罗哌卡因腰椎硬膜外联合麻醉组，每组25例，比较两组麻醉效果，采用自拟问卷调查表对两组患者危险因素进行非条件Logistic进行多因素分析。
结果与结论：①麻醉药物起效时间、局部麻醉诱导量、使用咪芬合剂次数、阻滞完善时间、麻醉后心率、并发症发生率罗哌卡因腰椎硬膜外联合麻醉组显著少于连续硬膜外麻醉组(P < 0.05)。②最高阻滞平面、Bromage评分、麻醉后平均动脉压和麻醉满意率罗哌卡因腰椎硬膜外联合麻醉组显著高于连续硬膜外麻醉组(P < 0.05)。③对入选患者术后认知功能障碍进行多因素Logistic分析结果显示，入选患者术后认知功能障碍与年龄、学历、并发症以及髋关节置换关系密切，差异有显著性意义(P < 0.05)。④结果证实，罗哌卡因腰椎硬膜外联合麻醉组在老年髋关节置换及植入物内固定治疗中效果理想，患者术后恢复快、安全可靠。
ORCID: 0000-0002-9258-7873 (李友安)

关键词: 骨科植入物, 人工假体, 罗哌卡因, 腰椎硬膜外联合麻醉, 老年髋关节置换, 植入物, 内固定, 麻醉效果, 连续硬膜外麻醉, 不良反应, 呼吸系统抑制

Abstract:

BACKGROUND: In the elderly patients with a variety of diseases, poor physical and compensatory ability results in a high demand for anesthesia during hip replacement and internal fixation. Lumbar epidural anesthesia with ropivacaine is the commonly used method of narcotic analgesics, but this method of anesthesia has been less studied in elderly hip replacement and internal fixation. 
OBJECTIVE: To investigate the effects of lumbar epidural anesthesia with ropivacaine in elderly hip replacement and internal fixation.
METHODS: Data of fifty elderly patients with hip replacement implants and internal fixation, who were treated in the Department of Orthopedics, Affiliated Hospital of Xizang Minzu University from February 2014 to August 2015, were analyzed. 50 patients were randomly divided into continuous epidural anesthesia group and ropivacaine lumbar epidural anesthesia group, with 25 patients in each group. Anesthetic effect was compared. Self questionnaire on risk factors was used for non-conditional Logistic multivariate analysis between the two groups.
RESULTS AND CONCLUSION: (1) Anesthetics onset time, the amount of local anesthesia, the use of trimetaphan camsilate agent number, complete block time, heart rate after anesthesia and complication rate were significantly less in the ropivacaine lumbar epidural anesthesia group than in the continuous epidural anesthesia group (P < 0.05). (2) The highest block level, Bromage score, mean arterial pressure after anesthesia and anesthesia satisfaction rate were significantly higher in the ropivacaine lumbar epidural anesthesia group than in the continuous epidural anesthesia group (P < 0.05). (3) Logistic multivariate analysis on postoperative cognitive dysfunction showed that postoperative cognitive dysfunction was strongly associated with age, education, complications, and hip arthroplasty (P < 0.05).
(4) Results verified that lumbar epidural anesthesia with ropivacaine showed ideal effects in hip arthroplasty and internal fixation. Postoperative recovery was rapid, and it is safe and reliable.