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目的：探讨老年股骨颈、粗隆间骨折开放手术腰—硬联合麻醉中脊麻合理用药剂量。方法52例ASAⅠ～Ⅲ级老年患者，采用L3～4腰—硬联合麻醉，脊麻采用0．4％等比重的左旋布比卡因，根据不同脊麻用药量分成A组（10mg）29例和B组23例（≤8mg）。对比不同剂量脊麻用药老年患者的呼吸循环不良事件发生率，给出老年患者脊麻合理用药量。结果不同年龄组间，脊麻前后心率和舒张压差异均无统计学意义（P＞0．05）。脊麻完成后30min内收缩压下降明显，差异有统计学意义（P＜0．01）。按年龄分组，Ⅱ亚组较Ⅰ亚组手术时间缩短，麻醉诱导期延长，但差异无统计学意义（ P＞0．05）。所有患者，脊麻后疼痛缓解率均达到100％，均能满足手术顺利完成，A组、B组疼痛缓解率差异无统计学意义（P＞0．05）。 B组脊麻后循环波动发生率为21．7％（5／23）明显低于A组的65．5％（19／29），差异有统计学意义（P＜0．01）；在A组（10mg），Ⅱ亚组较Ⅰ亚组更容易出现循环波动（P＜0．05）；在B组（≤8mg），Ⅱ亚组循环波动高于Ⅰ亚组，但差异无统计学意义（P＞0．05）。2组不同年龄段用药后心率失常、呼吸抑制和硬膜外追加用药率差异无统计学意义（P＞0．05）。结论75岁以上老年患者，≤6mg的左旋布比卡因脊麻更安全；小于75岁的老年患者，10mg的左旋布比卡因脊麻用量应列为禁忌。同时术前积极处理合并的基础性疾病，尽量缩短开放手术时间。重新定义麻醉诱导期，重在积极处理脊麻后循环波动，防止二次循环波动发生。“,”Objective To explore reasonable medication doses of the elderly during femoral neck and intertrochanteric fractures open surgery,allofthepatientsadoptcombinedspinal-epiduralanesthesia(CSEA).Methods 52ASAⅠ~Ⅲpa-tients undergoing femoral neck and intertrochanteric fractures open surgery were randomly divided into two groups according to the different medication doses A group (10mg) 29 cases.B group(≤8mg) 23 cases.They were treated with L-bupivacaine 10mg(group A) and L-bupivacaine do not exceed 8 mg(group B),To observe adverse events of circulation and respiration caused by spinal anesthesia with different doses in elderly patients .At last,elderly patients are given reasonable dose in spinal anesthesia.Results In different age groups,the heart rate,diastolic blood pressure after spinal anesthesia was no statistically significant(P>0.05).After completion of spinal anesthesia ,systolic blood pressure decreased significantly within 30min,the difference was statistically significant (P0.05).The pain relief rate was 100%,all patients can successfully complete the surgery .The pain relief rate of A group and B group has no statistically significant (P>0.05).The blood circulation fluctuation rate of B group (21.7%,5/23) was lower than that of A group(65.5%,19/29),the difference was statistically significant (P0.05).Conclusion Patients aged 75 years and older,≤6mg L-bupivacaine spinal anesthesia is more safe .In patients younger than 75 years old,the right spinal anesthesia dosage is not more than 8mg of L-bupivacaine.At the same time, Its were also important to preoperative treatment of basic diseases ,prolong anesthesia induction period ,try to shorten the opera-tion time.At last,we should renamed the meaning of “the anesthesia induction period” of elderly patients with spinal ,in order to actively processing cycle fluctuations after spinal anesthesia and prevent the secondary circulating fluctuation .