摘要
目的:探讨不同剂量罗哌卡因蛛网膜下腔麻醉对行髋关节置换术患者术后意识障碍程度、运动功能及转归的影响。方法:选取2021年1月~2022年1月在本院行髋关节置换术的120例患者作为研究对象,采用随机数字表法分为对照组和观察组,每组60例。对照组给予0.5%盐酸罗哌卡因溶液(脑脊液与1%的盐酸罗哌卡因注射液混合制成),观察组给予0.33%盐酸罗哌卡因溶液。比较两组镇痛效果、围手术期指标、认知功能、运动功能、血流动力学指标、术后转归及并发症。结果:术前两组视觉模拟评分(VAS)比较无统计学差异(P>0.05),术后24、48、72h两组VAS评分均降低,且观察组低于对照组(P<0.05);两组手术时间、术中出血量、术后住院时间比较均无统计学差异(P>0.05);术后两组简易智力状态检查(MMSE)、长谷川痴呆量表(HDS)评分均升高,且观察组各指标均高于对照组(P<0.05);术前两组Harris评分比较无统计学差异(P>0.05);术后7天、1个月、3个月两组Harris评分均升高,且观察组高于对照组(P<0.05);术后72h,两组心率、收缩压、舒张压均降低,且观察组各指标水平均低于对照组(P<0.05);两组术后谵妄、心脑血管并发症发生率比较均无统计学差异(P>0.05),但观察组术后首次下床时间低于对照组(P<0.05)。结论:较低剂量的罗哌卡因蛛网膜下腔麻醉对行髋关节置换术患者镇痛效果好,术后意识障碍程度影响较小,血流动力学平稳,运动功能及转归较好,建议临床推广。
Objective:To investigate the effect of ropivacaine subarachnoid anesthesia on the degree of consciousness disturbance,motor function and prognosis of patients undergoing hip arthroplasty.Methods:A total of 120 patients who underwent hip arthroplasty in our hospital from January 2021 to January 2022 were used as the research objects,and divided into control group and observation group by random number table method,60 cases in each group.The control group was given 0.5%ropivacaine hydrochloride solution(cerebrospinal fl uid mixed with 1%ropivacaine hydrochloride injection),and the observation group was given 0.33%ropivacaine hydrochloride solution.The analgesic eff ect,perioperative indicators,cognitive function,motor function,hemodynamic indicators,postoperative outcomes and complications were compared between the two groups.Result:There was no significant difference in VAS score between the two groups before operation(P>0.05).The VAS scores of the two groups were decreased at 24,48 and 72 h after operation,and the observation group was lower than the control group(P<0.05).There were no signifi cant diff erences in operation time,intraoperative bleeding and postoperative hospital stay between the two groups(P>0.05).After surgery,the MMSE and HDS of the two groups were signifi cantly increased,and the indexes of the observation group were higher than those of the control group(P<0.05).At 72 h after operation,heart rate,systolic blood pressure and diastolic blood pressure of the two groups were decreased,and the levels of each index in the observation group were lower than those in the control group(P<0.05).There was no signifi cant difference in postoperative delirium, cardiovascular and cerebrovascular complications between the two groups (P>0.05). However, the fi rst time out of bed in the observation group was signifi cantly lower than that in the control group (P<0.05). Conclusion: Low dose ropivacaine subarachnoid anesthesia has little eff ect on the degree of postoperative consciousness disorder in patients undergoing hip arthroplasty, and the motor function and prognosis are better. It is recommended to be popularized in clinic.
作者
高晓华
吴雷
吴瑞阳
韩灵龙
GAO Xiao-hua;WU Lei;WU Rui-Yang;HAN Ling-long(Department of Anesthesiology,Xuchang Central Hospital Affiliated to Henan University of Science and Technology,Xuchang 461000,China)
出处
《中国合理用药探索》
2022年第10期75-80,共6页
Chinese Journal of Rational Drug Use
基金
河南省医学科技攻关计划(LHGJ20191402)。
