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【摘要】目的研究小剂量低浓度轻比重布比卡因单侧腰硬联合阻滞在老年髋关节手术中的麻醉效果及围手术期麻醉不良反应。

方法选择拟行髋关节手术的80例患者，ASAⅠ～Ⅱ级，随机均分为0.375%布比卡因2.0 ml轻比重组和0.375%布比卡因2.0 ml等比重组，每组40例。分别评定两组麻醉效果及围手术期麻醉不良反应发生率。

结果两组患者麻醉效果均满意，感觉、运动阻滞起效时间及感觉、运动阻滞消退时间差异无统计学意义（P>0.05）。轻比重组围手术期总不良反应发生率明显低于等比重组，差异有统计学意义（P<0.05）。

结论小剂量低浓度轻比重布比卡因单侧腰硬联合阻滞在老年患者髋关节手术中麻醉效果满意，血流动力学更加平稳，围手术期麻醉不良反应少，是一种比较安全可靠的麻醉方法。

【关键词】布比卡因；单侧腰硬联合阻滞；老年；髋关节手术

中图分类号：R687.4；R614.4文献标识码：ADOI：10.3969/j.issn.10031383.2017.01.018

A study on clinic application of unilateral combined spinalepidural anesthesia on hip joint surgery for elderly patients

[HJ1][HJ]

MENG Shaoguang，MO Shaoping，LU Meixiang

（Department of Anesthesology，Binyang Hospital of Traditional Chinese Medicine，Binyang 530400，China）

[HJ2][HJ]

【Abstract】ObjectiveTo study anesthetic effect and adverse reactions of unilateral combined spinalepidural anesthesia on hip joint surgery for elderly patients with small dose and low concentration hypobaric bupivacaine.

Methods80 ASAⅠor ASAⅡpatients who planed to undergo hip joint surgery were selected，they were randomly divided into hypobaric group（2.0 ml of bupivacaine with 0.375%） and isobaric group（2.0 ml of bupivacaine with 0.375%） with 40 cases in each group.Anesthetic effects and the incident rate of adverse reactions during perioperative period were compared between the two groups.

ResultsThe anesthetic effects of the two groups were both obvious.Difference of the onset time of sensory and motor nerve block between the two groups was not statistically significant，so was the disappearing time（P>0.05）.Total incident rate of adverse reactions of the isobaric group during the preoperative period was significantly lower than that of the hypobaric group，so difference was statistically significant（P<0.05）.

ConclusionUnilateral combined spinalepidural anesthesia with small dose of low concentration hypobaric bupivacaine on hip joint surgery for elderly patients has satisfied anesthesia effects，haemodynamics is smooth，and adverse reactions are few during preoperative period.It is a safe and reliable anesthetic method.

【Key words】bupivacaine；unilateral combined spinalepidural anesthesia；elderly patients；hip joint surgery

隨着医学的发展和我国社会人口老龄化加速，老年患者全髋置换术及股骨头置换术逐年增多[1]。老年患者由于身体机能生理性退化，各脏器功能较脆弱，部分患者常合并内科基础疾病，增加了围手术期风险，麻醉不良反应发生率较高[2]。选择合适的麻醉方式对保证患者平稳度过围手术期显得非常重要。本研究观察小剂量低浓度轻比重布比卡因单侧腰硬联合阻滞在老年髋关节手术患者中的麻醉效果及围手术期麻醉不良反应，现报道如下。

1资料与方法

1.1临床资料

选取2015年1月至于2016年6月在我院接受髋关节择期手术老年患者80例为研究对象，纳入标准：美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级，无严重内科基础疾病，外科单病种手术患者，手术均在侧卧位下完成。……