小剂量不同浓度罗哌卡因麻醉在老年膝髋关节置换中的效果观察及安全性评价
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摘要
目的观察评价小剂量不同浓度罗哌卡因麻醉在老年膝髋关节置换中的效果及安全性。方法随机选取本院2017年1月至2018年6月期间收治的68例行膝髋关节置换术患者作为观察对象。依照入院顺序将其分为观察组和对照组,各34例,两组患者均选择L_(2～3)作为穿刺节段,给予对照组患者0.75%罗哌卡因15 ml,观察组患者给予0.5%罗哌卡因15 ml,对两组麻醉效果及安全性进行评价。结果观察组患者的感觉阻滞起效时间、运动阻滞起效时间、运动阻滞恢复时间及术中出血量均显著少于对照组,组间数据对比差异具有统计学意义(P<0.05);同时观察组患者术后不良反应发生率与对照组相比较低,两组数据差异具有统计学意义(P<0.05)。结论在老年患者膝髋关节置换中给予0.5%罗哌卡因15 ml麻醉的效果最佳,且安全性较高,可有效减少患者术中出血量,值得临床推广应用。
Objective To observe and evaluate the efficacy and safety of ropivacaine anesthesia in old knee hip arthroplasty. Methods 68 patients with knee hip arthroplasty admitted to our hospital from January 2017 to June 2018 were randomly selected for observation. According to the order of admission, it was divided into 34 cases in the observation group and the control group. Both groups chose L_(2-3) as the puncture segment, giving 0.75 % of ropivacaine 15 ml in the control group, and 0.5% of ropivacaine 15 ml in the observation group. The effect and safety of two groups of anesthesia were evaluated. Results The time of effect of sensory block, motion block, recovery time of motion block and bleeding in operation were all significantly less than those of control group(P<0.05). At the same time, the incidence of postoperative ADR was lower than that of the control group, and the data were significantly different, which was statistically significant(P<0.05). Conclusion 0.5% ropivacaine in knee hip arthroplasty in elderly patients has the best effect and high safety. It can effectively reduce the bleeding in the operation and is worthy of clinical application.
Objective To observe and evaluate the efficacy and safety of ropivacaine anesthesia in old knee hip arthroplasty. Methods 68 patients with knee hip arthroplasty admitted to our hospital from January 2017 to June 2018 were randomly selected for observation. According to the order of admission, it was divided into 34 cases in the observation group and the control group. Both groups chose L_(2-3) as the puncture segment, giving 0.75 % of ropivacaine 15 ml in the control group, and 0.5% of ropivacaine 15 ml in the observation group. The effect and safety of two groups of anesthesia were evaluated. Results The time of effect of sensory block, motion block, recovery time of motion block and bleeding in operation were all significantly less than those of control group(P<0.05). At the same time, the incidence of postoperative ADR was lower than that of the control group, and the data were significantly different, which was statistically significant(P<0.05). Conclusion 0.5% ropivacaine in knee hip arthroplasty in elderly patients has the best effect and high safety. It can effectively reduce the bleeding in the operation and is worthy of clinical application.
引文
[1]魏长娜,王琛,单海华,等.不同浓度罗哌卡因连续髂筋膜腔隙阻滞用于全髋关节置换术病人术后镇痛的效果[J].中华麻醉学杂志,2017,10(7):24-25.
[2] Abbas M, Ahmad L, Shah Y, et al. Development of a method tomeasure free and bound ropivacaine in human plasma using equi-librium dialysis and hydrophilic interaction chromatography cou-pled to high resolution mass spectrometry[J]. Talanta, 2017, 15(7):1260-1263.
[3]付俊,肖昀,钟和英,等.轻比重罗哌卡因单侧连续腰麻用于老年患者全髋关节置换术[J].湖北医药学院学报,2017,4(5):62-63.
[4]徐俊峰,林梅,谢颖祥.两种不同的麻醉方式用于老年全髋关节置换术患者术后麻醉恢复期效果对比[J].中国老年学杂志,2016,30(4):89-90.
[5] Kuchálik J, Granath B, Ljunggren A, et al. Postoperative pain reliefafter total hip arthroplasty:a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia[J].Br J Anaesth, 2016,111(5):793-799.
[6]杨家道,谭燕萍,秦用华,等.舒芬太尼复合罗哌卡因与芬太尼复合罗哌卡因在分娩镇痛临床应用中的比较[J].中国现代医学杂志,2017,10(7):24-25.
[7] Solovyova O, Lewis CG, Abrams JH, et al. Local infiltration analge-sia followed by continuous infusion of local anesthetic solution fortotal hip arthroplasty:a prospective, randomized, doubleblind, placebo-controlled study[J]. J Bone Joint Surg Am, 2016,95(21):1935-1941.
[8]王玺,余湘元,朱建华,等.不同麻醉方法对老年患者人工髋关节置换手术后认知功能的影响[J].医学临床研究,2017,5(3):67-69.
[9] Den Hartog YM, Mathijssen NM, van Dasselaar NT, et al. No effectof the infiltration of local anaesthetic for total hip arthroplasty usingan anterior approach:A randomised placebo controlled trial[J].Bone Joint J, 2015,97(6):734-740.
[10]李蕊.罗哌卡因腰-硬联合麻醉在高龄患者髋部及下肢骨科手术中的应用[J].中华实用诊断与治疗杂志,2017,4(5):62-63.
[2] Abbas M, Ahmad L, Shah Y, et al. Development of a method tomeasure free and bound ropivacaine in human plasma using equi-librium dialysis and hydrophilic interaction chromatography cou-pled to high resolution mass spectrometry[J]. Talanta, 2017, 15(7):1260-1263.
[3]付俊,肖昀,钟和英,等.轻比重罗哌卡因单侧连续腰麻用于老年患者全髋关节置换术[J].湖北医药学院学报,2017,4(5):62-63.
[4]徐俊峰,林梅,谢颖祥.两种不同的麻醉方式用于老年全髋关节置换术患者术后麻醉恢复期效果对比[J].中国老年学杂志,2016,30(4):89-90.
[5] Kuchálik J, Granath B, Ljunggren A, et al. Postoperative pain reliefafter total hip arthroplasty:a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia[J].Br J Anaesth, 2016,111(5):793-799.
[6]杨家道,谭燕萍,秦用华,等.舒芬太尼复合罗哌卡因与芬太尼复合罗哌卡因在分娩镇痛临床应用中的比较[J].中国现代医学杂志,2017,10(7):24-25.
[7] Solovyova O, Lewis CG, Abrams JH, et al. Local infiltration analge-sia followed by continuous infusion of local anesthetic solution fortotal hip arthroplasty:a prospective, randomized, doubleblind, placebo-controlled study[J]. J Bone Joint Surg Am, 2016,95(21):1935-1941.
[8]王玺,余湘元,朱建华,等.不同麻醉方法对老年患者人工髋关节置换手术后认知功能的影响[J].医学临床研究,2017,5(3):67-69.
[9] Den Hartog YM, Mathijssen NM, van Dasselaar NT, et al. No effectof the infiltration of local anaesthetic for total hip arthroplasty usingan anterior approach:A randomised placebo controlled trial[J].Bone Joint J, 2015,97(6):734-740.
[10]李蕊.罗哌卡因腰-硬联合麻醉在高龄患者髋部及下肢骨科手术中的应用[J].中华实用诊断与治疗杂志,2017,4(5):62-63.