摘要
目的探讨不同浓度罗哌卡因腰硬联合麻醉在老年髋关节置换术中的应用效果,并分析术后谵妄的发生情况。方法选取2022年1—12月在鹤壁煤业(集团)有限责任公司总医院102例行单侧腰硬膜联合的髋关节置换术老年患者,随机分为3组,观察A组、观察B组和观察C组,各34例,分别给予2.5、5.0、7.5 g·L^(-1)的盐酸罗哌卡因麻醉,比较各组手术时间及麻醉效果,麻醉前(T_(0))、麻醉15 min后(T_(1))、麻醉30 min后(T_(2))及手术结束时(T_(3))心率(HR)、平均动脉压(MAP),术前、术后1 h、术后6 h、术后24 h、术后72 h的谵妄量表分析系统(CAM-CR)评分,以及不良反应发生情况。结果3组手术时间比较,差异无统计学意义(P>0.05)。3组感觉阻滞起效时间、运动阻滞起效时间比较:观察A组>观察B组>观察C组(P<0.05)。3组感觉阻滞恢复时间、运动阻滞恢复时间比较:观察A组<观察B组<观察C组(P<0.05)。在T_(1)、T_(2)、T_(3)时点,两组HR、MAP较T_(0)时点均降低(P<0.05)。3组HR、MAP比较:观察A组>观察B组>观察C组,差异有统计学意义(P<0.05)。术后1、6 h观察A组、观察B组CAM-CR评分较术前均升高(P<0.05),术后1、6、24 h观察C组CAM-CR评分较术前均升高(P<0.05),术后1、6、24 h观察A组、观察B组CAM-CR评分低于观察C组(P<0.05),术后72 h 3组CAM-CR评分比较,差异无统计学意义(P>0.05)。3组不良反应发生率比较,差异无统计学意义(P>0.05)。结论2.5 g·L^(-1)的罗哌卡因腰硬联合麻醉应用在老年髋关节置换术中,感觉和运动阻滞起效快,更有利于稳定生命体征,术后谵妄程度轻,且安全性高。
Objective To investigate the effect of combined spinal-epidural anesthesia with different concentrations of ropivacaine in elderly patients undergoing hip replacement,and to analyze the incidence of postoperative delirium.Methods A total of 102 elderly patients who underwent unilateral spinal-epidural joint hip replacement in Hebi Coal Industry(Group)Co.,Ltd.General Hospital from January to December 2022 were randomly divided into three groups,observation group A,observation group B and observation group C,with 34 cases in each group,and were given 2.5,5.0,7.5 g·L^(-1) ropivacaine hydrochloride anesthesia respectively.The operation time and anesthesia effect of each group were compared.Heart rate(HR)and mean arterial pressure(MAP)before anesthesia(T_(0)),after anesthesia for 15 minutes(T_(1)),after anesthesia for 30 minutes(T_(2))and at the end of operation(T_(3)),delirium analysis system(CAM-CR)scores before surgery,1 hour after surgery,6 hours after surgery,24 hours after surgery and 72 hours after surgery,and the occurrence of adverse reactions.Results There was no statistical significance in the comparison of operation time among the three groups(P>0.05).The comparison of onset time of sensory block and motor block among the three groups was as follows:observation group A>observation group B>observation group C(P<0.05).The comparison of recovery time of sensory block and motor block among the three groups was as follows:observation group A<observation group B<observation group C(P<0.05).At T_(1),T_(2) and T_(3),the HR and MAP of the two groups were lower than those at T_(0)(P<0.05),and the comparison of HR and MAP of the three groups:observation group A>observation group B>observation group C,the differences were statistically significant(P<0.05).The CAM-CR score of observation group A and observation group B was increased 1 and 6 h after surgery(P<0.05),and the CAM-CR score of observation group C was increased 1,6 and 24 h after surgery(P<0.05).The CAM-CR score of observation group A and observation group B was lower than that of observation group C at 1,6 and 24 h after surgery(P<0.05),and there was no statistical significance in CAM-CR score among 3 groups at 72 h after surgery(P>0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion The application of 2.5 g·L^(-1) ropivacaine combined with spinal-epidural anesthesia in elderly hip replacement has the advantages of quick onset of sensory and motor block,more conducive to stabilizing vital signs,less postoperative delirium and high safety.
作者
方园
孔德华
李安超
FANG Yuan;KONG Dehua;LI Anchao(Anesthesiology Department,Hebi Coal Industry(Group)Co.,Ltd.General Hospital,Hebi 458000,China)
出处
《河南医学研究》
CAS
2024年第13期2373-2377,共5页
Henan Medical Research
关键词
不同浓度
罗哌卡因
腰硬联合麻醉
老年髋关节置换术
生命体征
运动阻滞
different concentration
ropivacaine
combined spinal-epidural anesthesia
elderly hip replacement
vital signs
motor block
