| objective: To observe the effect of spinal anesthesia with different doses of bupivacaine diluted with cerebrospinal fluid on elderly patients undergoing hip surgery.Methods:A total of 140 elderly patients undergoing hip surgery under combined spinal-epidural anesthesia in our hospital from December 2020 to February 2022 were selected.During drainage,anesthesia was changed in 2 cases,blood loss exceeded 400 ml in 1 case.A total of 3 cases were excluded,and finally included in 137 cases.The patients were randomly divided into observation group A,B,C and control group D,the dosage of bupivacaine was 3.75 mg in group A,5.0 mg in group B,7.5 mg in group C and 10 mg in group D,the volume of bupivacaine was 2ml.The incidence of hypotension,the change of blood pressure at different time points,the use of pressor drugs,the time of operation,the amount of input and output,and the effect of anesthesia block were compared among the four groups.Results:The overall incidence of hypotension in group A（24.2 %）and group B（17.6 %）was lower than that in group D（57.1 %）,and the difference was statistically significant（P<0.05）.The incidence of early hypotension in group A（0 %）was significantly lower than that in group C（40.0 %）and group D（54.3 %）（P<0.05）,and that in group B（8.8 %）was lower than that in group D（P<0.05）.The use of pressor drugs: there was no difference among the four groups（P>0.05）.The time of using pressor drugs for the first time in group A（50.8±23.8 min）was longer than that in group C（12.5±5.1 min）and group D（10.0±4.7 min）,and there was significant difference（P <0.001）.The changes of blood pressure and heart rate at different time points in each group: in group A,the diastolic blood pressure at T5 was 3.1 mm Hg lower than that at T1,and the heart rate at T2 and T7 was 2.4 bpm and 3.9 bpm higher than that at T1,respectively,and the difference was statistically significant（P<0.05）.In group B,the heart rate at T5 and T6 was 2.5 bpm and3.0 bpm lower than that at T1,respectively,and the difference was statistically significant（P<0.05）.In group C,the diastolic blood pressure at T4 and T6 was 2.8 mm Hg and 3.5mm Hg lower than that at T1,respectively,and the difference was statistically significant（P<0.05）.In group D,the systolic blood pressure and diastolic blood pressure at each time point were lower than those at T1 time,and the difference was statistically significant（P<0.05）.The average value of the maximum decrease was 14.5mm Hg and 8.2mm Hg,respectively.The heart rate at T6 was 4.3 bpm lower than that at T1,and the difference was statistically significant（P<0.05）.The duration of sensory nerve block: there was significant difference among the four groups（P<0.001）.The shortest in group A（72.9 ±21 min）was significantly higher than that in group B（118.1 ±31.0 min）,group C（168.1±48.9 min）and group D（244.0 ±19.0 min）,and the longest in group D was significantly longer than that in group A,B and C,and the difference was statistically significant（P<0.05）.Epidural use: there was significant statistical difference among the four groups（P<0.001）.The utilization rate of group A（81.8 %）was the highest,which was higher than that of group B（38.2 %）,group C（14.3 %）and group D（2.9 %）,Group B is higher than group D,and the difference was statistically significant（P<0.05）.The duration of motor nerve block was significantly different among the four groups（P < 0.001）.Group D（268（257 + 283）min）is the longest,which was significantly different from that in group A（162（135/211）min）,group B（148（125/168）min）and group C（221（199/239）min）（P< 0.001）,group A and group B are the shortest.Conclusion : When 5mg bupivacaine spinal anesthesia solution diluted with cerebrospinal fluid is used for hip surgery in elderly patients,the hemodynamics of the patients is stable,the incidence of hypotension is low,and it can provide satisfactory anesthetic effect and reduce the amount of epidural medication.When the operation time is about 110 min,it is recommended for clinical use. |
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