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随着年龄的增长,身体代谢逐渐缓慢,再加上饮食结构的变化,老年人胃肠吸收功能不断下降,摄入的钙元素减少,吸收亦减少,但丢失增加,导致骨脆性增加,因此导致股骨头骨折、股骨颈骨折及股骨粗隆间骨折等的发病率不断升高[1]。为了让高龄病人尽早恢复、减少卧床时间,大部分病人都选择股骨头置换术治疗,但因高龄病人生理机能减退且并发多种慢性病、多系统器官功能障碍等疾病,增加了手术麻醉的风险[2]。有研究[3]显示,腰丛-坐骨神经阻滞及腰硬联合麻醉这2种麻醉方式均可用于高龄病人股骨头置换术,但麻醉效果有稍许差异;为了探索更为安全有效的麻醉方式,本研究选取78例高龄股骨头置换术病人分别实施腰丛-坐骨神经阻滞(神经阻滞组)及腰硬联合麻醉(腰硬组),对比二者麻醉效果。现作报道。
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麻醉前,2组病人血压和心率比较差异无统计学意义(P>0.05),经不同阻滞后,2组病人心率及舒张压比较差异无统计学意义(P>0.05),但神经阻滞组收缩压显著高于腰硬组(P < 0.01);且麻醉后2组血压均较麻醉前下降(P < 0.05~P < 0.01),腰硬组心率较麻醉前下降(P < 0.05),神经阻滞组麻醉前后心率差异无统计学意义(P>0.05)(见表 1)。
分组 n 收缩压/mmHg 舒张压/mmHg 心率/(次/分) 麻醉前 腰硬组 39 147.43±20.18 76.98±15.21 89.01±16.23 神经阻滞组 39 146.76±21.09 77.23±15.32 87.91±15.43 t — 0.14 0.07 0.31 P — >0.05 >0.05 >0.05 麻醉后 腰硬组 39 119.43±10.18** 68.23±10.02** 79.76±15.67* 神经阻滞组 39 126.23±11.23** 70.69±10.74* 82.00±15.32 t — 2.80 1.05 0.64 P — < 0.01 >0.05 >0.05 组内配对t检验:与麻醉前比较*P < 0.05, **P < 0.01 表 1 2组麻醉前后收缩压、舒张压、心率的改善情况比较(x±s)
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麻醉前2组病人均表现为重度疼痛,差异无统计学意义(P>0.05);经麻醉后,腰硬组VAS评分明显低于神经阻滞组(P < 0.01);且麻醉后2组VAS评分均显著低于麻醉前(P < 0.01)(见表 2)。
分组 n 麻醉前 麻醉后 t P 腰硬组 39 8.03±2.18 0.37±0.09△△ 21.92 < 0.01 神经阻滞组 39 8.11±2.09 1.73±0.41△△ 18.71 < 0.01 t — 0.17 20.23* — — P — >0.05 < 0.01 — — 组内配对t检验:△△P < 0.01;*示t′检验 表 2 2组病人麻醉前后疼痛情况比较(x±s;分)
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研究显示, 腰硬组术中麻黄碱用量、补液量均显著多于神经阻滞组(P < 0.01),腰硬组术中镇痛药物用量少于神经阻滞组(P < 0.05)(见表 3)。
分组 n 麻黄碱/mg 补液/(mL·kg-1·h-1) 氟比洛芬酯/mg 腰硬组 39 13.21±3.77 6.25±1.03 45.10±10.08 神经阻滞组 39 4.76±1.21 5.02±1.01 50.31±10.01 t — 13.33* 5.32 2.29 P — < 0.01 < 0.01 < 0.05 *示t′值 表 3 2组病人术中血管活性药物及镇痛药物的使用情况比较(x±s)
腰丛-坐骨神经阻滞及腰硬联合麻醉在高龄病人股骨头置换术中的麻醉效果分析
Comparsion analysis of the anesthetic effects between lumbar plexus-sciatic nerve block and combined spinal-epidural anesthesia in elderly patients treated with femoral head replacement
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摘要:
目的探讨高龄病人股骨头置换术中实施腰丛-坐骨神经阻滞及腰硬联合麻醉的麻醉效果差异。 方法选取78例病人为研究对象,按麻醉方式的不同将其分为2组,实施腰硬联合麻醉的39例为腰硬组,实施腰丛-坐骨神经阻滞麻醉的39例为神经阻滞组。观察2组麻醉阻滞前后的血流动力学变化、疼痛视觉模拟量表(VAS)评分,术中血管活性药物及镇痛药物的使用情况。 结果麻醉前,2组病人血压和心率比较差异均无统计学意义(P>0.05),经不同阻滞后,2组病人心率及舒张压差异均无统计学意义(P>0.05),但收缩压神经阻滞组显著高于腰硬组(P < 0.01)。且麻醉后2组血压均较麻醉前下降(P < 0.05~P < 0.01),腰硬组心率较麻醉前下降(P < 0.05),神经阻滞组麻醉前后心率差异无统计学意义(P>0.05)。经麻醉后,腰硬组VAS评分明显低于神经阻滞组(P < 0.01);2组VAS评分均显著低于麻醉前(P < 0.01)。腰硬组术中麻黄碱用量、补液量均显著多于神经阻滞组(P < 0.01),腰硬组术中镇痛药物用量少于神经阻滞组(P < 0.05)。 结论腰丛-坐骨神经阻滞及腰硬联合麻醉均可用于高龄病人股骨头置换术,2种麻醉方式对病人血流动力学均无明显影响,其中腰硬联合麻醉术中镇痛药物用量少,镇痛效果显著,在实际临床麻醉中应充分考虑病人实际情况选择合适的麻醉方式。 Abstract:ObjectiveTo investigate the differences of anesthesia effects between lumbar plexus-sciatic nerve block and combined spinal-epidural anesthesia in elderly patients treated with femoral head replacement. MethodsA total of 78 patients treated with femoral head replacement were divided into two groups according to different anesthesia methods.Thirty-nine patients treated with combined lumbar-epidural anesthesia and 39 cases treated with lumbar plexus-sciatic nerve block were divided into the spinal-epidural group and nerve block group, respectively.The hemodynamic changes and VAS score before and after anesthesia, intraoperative vasoactive drugs and analgesic drugs were observed in two groups. ResultsThere was no statistical significance in blood pressure and heart rate between two groups before anesthesia (P>0.05).After anesthesia, the difference of the heart rate and diastolic blood pressure between two groups were not statistically significant (P>0.05), and the level of systolic pressure in nerve block group was higher than that in spinal-epidural group (P < 0.01).After anesthesia, the blood pressure levels in two groups decreased compared with before anesthesia (P < 0.05 to P < 0.01), the heart rate in spinal-epidural group decreased compared with before anesthesia (P < 0.05), and the difference of the heart rate in nerve block group was not statistically significant between before and after anesthesia (P>0.05).After anesthesia, the VAS score in spinal-epidural group was significantly lower than that in nerve block group (P < 0.01), and the VAS scores in two groups were significantly lower than those before anesthesia (P < 0.01) The amount of intraoperative ephedrine and fluid supplementation in spinal-epidural group were significantly higher than those in nerve block group (P < 0.01), and the amount of intraoperative analgesic drugs in spinal-epidural group was lower than that in nerve block group (P < 0.05). ConclusionsLumbar plexus-sciatic nerve block and combined spinal-epidural anesthesia can be used in elderly patients treated with femoral head replacement.The two anesthesia methods have not significant effects on the hemodynamics of patients, the amount of analgesic drugs in combined spinal-epidural anesthesia is less, and the analgesic effect is significant.In the actual clinical anesthesia, we should fully consider the actual situation of patients to choose the appropriate anesthesia. -
表 1 2组麻醉前后收缩压、舒张压、心率的改善情况比较(x±s)
分组 n 收缩压/mmHg 舒张压/mmHg 心率/(次/分) 麻醉前 腰硬组 39 147.43±20.18 76.98±15.21 89.01±16.23 神经阻滞组 39 146.76±21.09 77.23±15.32 87.91±15.43 t — 0.14 0.07 0.31 P — >0.05 >0.05 >0.05 麻醉后 腰硬组 39 119.43±10.18** 68.23±10.02** 79.76±15.67* 神经阻滞组 39 126.23±11.23** 70.69±10.74* 82.00±15.32 t — 2.80 1.05 0.64 P — < 0.01 >0.05 >0.05 组内配对t检验:与麻醉前比较*P < 0.05, **P < 0.01 表 2 2组病人麻醉前后疼痛情况比较(x±s;分)
分组 n 麻醉前 麻醉后 t P 腰硬组 39 8.03±2.18 0.37±0.09△△ 21.92 < 0.01 神经阻滞组 39 8.11±2.09 1.73±0.41△△ 18.71 < 0.01 t — 0.17 20.23* — — P — >0.05 < 0.01 — — 组内配对t检验:△△P < 0.01;*示t′检验 表 3 2组病人术中血管活性药物及镇痛药物的使用情况比较(x±s)
分组 n 麻黄碱/mg 补液/(mL·kg-1·h-1) 氟比洛芬酯/mg 腰硬组 39 13.21±3.77 6.25±1.03 45.10±10.08 神经阻滞组 39 4.76±1.21 5.02±1.01 50.31±10.01 t — 13.33* 5.32 2.29 P — < 0.01 < 0.01 < 0.05 *示t′值 -
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