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摘 要 目的：探讨高龄患者髋及下肢手术小剂量单侧腰麻醉效果。方法：收治髋及下肢手术的高龄患者280例，随机分成A、B两组各10例，两组均采用腰-硬联合麻醉针穿刺，A组注入0.75%布比卡因0.6～1.2ml+10%葡萄糖0.8～1.5ml之重比重混合液1.5～2.5ml进行麻醉；B组注入0.75%布比卡因1.3～1.8ml+10%葡萄糖1～2ml之重比重混合液2.5～3.5ml进行麻醉。结果：两组麻醉效果比较：A组麻醉前MAP（111.7±23.7）mmHg，麻醉后（107.5±21.8）mmHg，B组麻醉前（113.3±23.2）mmHg，麻醉后（97.3±24.7）mmHg。A组HR麻醉前（77.4±18.6）次/分，麻醉后（76.6±15.7）次/分，B组麻醉前（76.4±17.5）次/分，麻醉后（73.3±17.0）次/分，B组MAP、HR下降明显，与A组比较差异有统计学意义（P<0.05）。结论：小剂量单侧腰麻在高龄患者髋及下肢手术麻醉效果好。
关键词 高龄 髋骨 下肢 单侧腰麻 小剂量
Abstract Objective：We want to investigate the effect of the elderly patients with hip and lower extremity operation using small dose of unilateral spinal anesthesia.Methods：We selected 280 patients in 2009 October to 2013 September，and these patients were randomly divided into A，B two groups.All two groups use combined spinal-epidural anesthesia.Group A was injected 1.5～2.5ml mixed liquid of anesthesia，the mixture is made up of 0.75% bupivacaine 0.6～1.2ml+10% glucose 0.8～1.5ml.Group B was injected 2.5～3.5ml mixed liquid of anesthesia，the mixture is made up of 0.75% bupivacaine 1.3～1.8ml+10% glucose 1～2ml.Results：The anesthesia effect of two groups is shown as follows：The MAP before anesthesia in group A is 111.7±23.7mmHg and is 107.5±21.8mmHg after anesthesia.The MAP before anesthesia in group B is 113.3±23.2mmHg and is 97.3±24.7mmHg after anesthesia.The HR before anesthesia in group A is 77.4±18.6/min and is 76.6±15.7/min after anesthesia.The HR before anesthesia in group B is 76.4±17.5/min and is 73.3±17.0/min after anesthesia.Results show that the B group of MAP and HR decreased significantly，the difference compared with the A group had significant difference（P<0.05）.Conclusion：The effect of unilateral spinal anesthesia with small dose in elderly patients with hip and lower extremity operation is good，and this method is worth spreading in clinic.
Key words Advanced age；Hip；lower limbs；Unilateral spinal anesthesia；Small dose
资料与方法
2009年10月-2013年9月收治髋及下肢手术的高龄患者280例，年龄73～84岁，平均78.1岁，ASA Ⅰ～Ⅲ级。术前合并肺心病14例，高血压病91例，慢性支气管炎42例，糖尿病42例。随机分成A、B 两组各10例，两组在年龄、性别等方面差异无统计学意义，有可比性。
麻醉方法：两组术前10分钟肌注阿托品0.5mg、咪唑安定2.5mg。取侧卧位，患肢在下，选L2～3或L3～4间隙，采用腰-硬联合麻醉针穿刺[1]。硬膜外穿刺成功后，将腰麻针通过硬膜外穿刺针刺入蛛网膜下隙，见脑脊液后，A组注入0.75%布比卡因0.6～1.2ml+10%葡萄糖0.8～1.5ml之重比重混合液1.5～2.5ml进行麻醉；B组注入0.75%布比卡因1.3～1.8ml+10%葡萄糖1～2ml之重比重混合液2.5～3.5ml进行麻醉。
结 果
两组麻醉效果比较：A组麻醉前MAP（111.7±23.7）mmHg，麻醉后（107.5±21.8）mmHg，B组麻醉前（113.3±23.2）mmHg，麻醉后（97.3±24.7）mmHg。HR麻醉前（77.4±18.6）次/分，麻醉后（76.6±15.7）次/分，B组麻醉前（76.4±17.5）mmHg，麻醉后（73.3±17.0）次/分，B组MAP、HR下降明显，与A组比较差异有统计学意义（P<0.05），见表1。 讨 论
腰麻在下肢手术中被广泛使用[2，3]，但是，双侧普通剂量的腰麻对高龄患者有很大缺陷，因其阻滞范围广，易引起低血压，而平均动脉压下降导致冠脉血流减少，可能造成严重不良后果[4，5]。单侧腰麻一般指一侧的脊神经根被阻滞，但是实际上并非阻滞局限于一侧，而是两侧阻滞平面不对称。如取侧卧位，患侧在下，使用重比重溶液，注射药物时穿刺针斜面向下，可使患侧阻滞平面高于健侧，而且作用时间也长于健侧。
由本文结果可见，小剂量单侧腰麻在高龄病人髋及下肢手术麻醉效果好，值得临床推广。
参考文献
1 Yost NP，bloom SL，Sibly MK，et al.A hospital-sponsored quality improvement study of pain management after cesarean delivery[J].Am J Obstet Gynecol，2004，190：1341-1346.
2 Pernikoff BJ，eisenstat TE，rubin RJ，et al.reappraisal of partial lateral internal sphincterotomy[J].Dis Colon Rectum，2011，37：1291-1295.
3 DcAngelo R，Geran cher JC，Eisenach JC，et al.Epidural f ent anylproduces labor analgesia by a spinal mechanism.Anesthesiology，2008，88：1519-1523.
4 Nunzio C.The evolution of detrusor overactivity after watchful waiting，medical-therapy and surgery in patients with bladder outlet obstruction[J]..J Urol，2003，169：535-539.
5 Greenwald JA，McMullen HF，Coppa GF，et al.Standardization of surgeon cont rolled variables.Impact on outcome in patient swith acute cholecystitis[J].Annals of Surgery，2010，231（3）：339.
关键词 高龄 髋骨 下肢 单侧腰麻 小剂量
Abstract Objective：We want to investigate the effect of the elderly patients with hip and lower extremity operation using small dose of unilateral spinal anesthesia.Methods：We selected 280 patients in 2009 October to 2013 September，and these patients were randomly divided into A，B two groups.All two groups use combined spinal-epidural anesthesia.Group A was injected 1.5～2.5ml mixed liquid of anesthesia，the mixture is made up of 0.75% bupivacaine 0.6～1.2ml+10% glucose 0.8～1.5ml.Group B was injected 2.5～3.5ml mixed liquid of anesthesia，the mixture is made up of 0.75% bupivacaine 1.3～1.8ml+10% glucose 1～2ml.Results：The anesthesia effect of two groups is shown as follows：The MAP before anesthesia in group A is 111.7±23.7mmHg and is 107.5±21.8mmHg after anesthesia.The MAP before anesthesia in group B is 113.3±23.2mmHg and is 97.3±24.7mmHg after anesthesia.The HR before anesthesia in group A is 77.4±18.6/min and is 76.6±15.7/min after anesthesia.The HR before anesthesia in group B is 76.4±17.5/min and is 73.3±17.0/min after anesthesia.Results show that the B group of MAP and HR decreased significantly，the difference compared with the A group had significant difference（P<0.05）.Conclusion：The effect of unilateral spinal anesthesia with small dose in elderly patients with hip and lower extremity operation is good，and this method is worth spreading in clinic.
Key words Advanced age；Hip；lower limbs；Unilateral spinal anesthesia；Small dose
资料与方法
2009年10月-2013年9月收治髋及下肢手术的高龄患者280例，年龄73～84岁，平均78.1岁，ASA Ⅰ～Ⅲ级。术前合并肺心病14例，高血压病91例，慢性支气管炎42例，糖尿病42例。随机分成A、B 两组各10例，两组在年龄、性别等方面差异无统计学意义，有可比性。
麻醉方法：两组术前10分钟肌注阿托品0.5mg、咪唑安定2.5mg。取侧卧位，患肢在下，选L2～3或L3～4间隙，采用腰-硬联合麻醉针穿刺[1]。硬膜外穿刺成功后，将腰麻针通过硬膜外穿刺针刺入蛛网膜下隙，见脑脊液后，A组注入0.75%布比卡因0.6～1.2ml+10%葡萄糖0.8～1.5ml之重比重混合液1.5～2.5ml进行麻醉；B组注入0.75%布比卡因1.3～1.8ml+10%葡萄糖1～2ml之重比重混合液2.5～3.5ml进行麻醉。
结 果
两组麻醉效果比较：A组麻醉前MAP（111.7±23.7）mmHg，麻醉后（107.5±21.8）mmHg，B组麻醉前（113.3±23.2）mmHg，麻醉后（97.3±24.7）mmHg。HR麻醉前（77.4±18.6）次/分，麻醉后（76.6±15.7）次/分，B组麻醉前（76.4±17.5）mmHg，麻醉后（73.3±17.0）次/分，B组MAP、HR下降明显，与A组比较差异有统计学意义（P<0.05），见表1。 讨 论
腰麻在下肢手术中被广泛使用[2，3]，但是，双侧普通剂量的腰麻对高龄患者有很大缺陷，因其阻滞范围广，易引起低血压，而平均动脉压下降导致冠脉血流减少，可能造成严重不良后果[4，5]。单侧腰麻一般指一侧的脊神经根被阻滞，但是实际上并非阻滞局限于一侧，而是两侧阻滞平面不对称。如取侧卧位，患侧在下，使用重比重溶液，注射药物时穿刺针斜面向下，可使患侧阻滞平面高于健侧，而且作用时间也长于健侧。
由本文结果可见，小剂量单侧腰麻在高龄病人髋及下肢手术麻醉效果好，值得临床推广。
参考文献
1 Yost NP，bloom SL，Sibly MK，et al.A hospital-sponsored quality improvement study of pain management after cesarean delivery[J].Am J Obstet Gynecol，2004，190：1341-1346.
2 Pernikoff BJ，eisenstat TE，rubin RJ，et al.reappraisal of partial lateral internal sphincterotomy[J].Dis Colon Rectum，2011，37：1291-1295.
3 DcAngelo R，Geran cher JC，Eisenach JC，et al.Epidural f ent anylproduces labor analgesia by a spinal mechanism.Anesthesiology，2008，88：1519-1523.
4 Nunzio C.The evolution of detrusor overactivity after watchful waiting，medical-therapy and surgery in patients with bladder outlet obstruction[J]..J Urol，2003，169：535-539.
5 Greenwald JA，McMullen HF，Coppa GF，et al.Standardization of surgeon cont rolled variables.Impact on outcome in patient swith acute cholecystitis[J].Annals of Surgery，2010，231（3）：339.