摘要
Abstract
Objective To explore the feasibility of the application of hypobaric anesthetics to subarachnoid block and safe dose range in elderly patients over 60.Methods 146 patients over 60 years old with spinal anesthesia and having undergone intertrochanteric fractures operation were selected in Peking University People′s Hospital from September 2006 to September 2012. They were divided into two groups according to age: group Ⅰ (n=74) aged 60-79, and group Ⅱ (n=72) aged ≥80. Both groups slowly received 0.2%hypobaric bupivacaine after a single dose of subarachnoid punctures in the clearance of L2-3 or L3-4 or combined spinal epidural anesthesia by one point method.The respective blood pressure before anesthesia, 5, 10, 20, 30, 60 minutes after anesthesia and after operation, dose of bupivacaine, level of anesthesia, transfusion quantities during anesthesia, use of paramedian approach or not, intra -operative blood loss, operation time were obtained by retrieving the electronic anesthesia data records.All the new postoperative complications were obtained by retrieving the electronic medical records system.The risk factors for following hypotension after spinal anesthesia were analyzed by Logistic regression.Results The differences in transfusion quantities, implementation of iliac fascia block, use of paramedian approach, use of vasoconstrictor drugs, postoperative complications, anesthesia level, operation time, intra -operative blood loss and hospital stay after operation were not significant between the two groups ( P>0.05); the difference in dose of bupivacaine was significant (P<0.05).The differences of mean blood pressure at different time points were not significant between the two groups (Finteration =0.325, Fintergroups =0.708, Ftime =14.202; Pinteraction =0.688, Pintergroups =0.402, Ptime <0.001).The mean pressure in both groups 5, 10, 20, 30, 60 min after spinal anesthesia all decreased (P<0.05).Logistic regression analysis revealed systolic pressure and level of anesthesia were the risk factors for hypotension after anesthesia ( P <0.05 ) . Conclusion This study recommended dose of bupivacaine is 8 -10 mg for patients over 80, and 9 -12 mg for patients between 60 and 79.The incidence of spinal anesthesia induced hypotension is so high that active application of vasoconstrictor drugs is necessary.关键词
老年人/蛛网膜下腔/麻醉/低血压Key words
Aged/Subarachnoid space/Anesthesia/Hypotension分类
医药卫生
