小剂量轻比重腰麻-硬膜外联合麻醉在老年下肢骨折手术患者中的应用

Application of Low-dose Light Specific Gravity Spinal Anesthesia Combined with Epidural Anesthesia in Elderly Patients with Lower Extremity Fracture Surgery

目的探讨小剂量轻比重腰麻-硬膜外联合麻醉在老年下肢骨折手术患者中的应用。方法选择2018年9月-2019年9月于该院进行手术治疗的老年下肢骨折患者82例,以随机数表法将其分为两组,即对照组与研究组各41例。对照组应用持续硬膜外麻醉,研究组应用小剂量轻比腰麻-硬膜外联合麻醉。对比两组感觉阻滞起效时间、麻醉维持时间、改良下肢运动阻滞程度评分(Bromage),以及麻醉相关并发症情况。结果研究组感觉阻滞起效时间(1.5±1.0)min低于对照组(2.1±0.5)min(t=3.436,P<0.01),Bromage评分(0.8±0.2)分低于对照组(1.6±0.3)分(t=14.207,P<0.01),研究组麻醉维持时间(179.3±16.5)min与对照组(180.3±14.6)min对比差异无统计学意义(t=0.291,P>0.05)。研究组麻醉相关并发症发生率为2.44%低于对照组19.51%(χ^2=6.116,P<0.05)。结论小剂量轻比重腰麻-硬膜外联合麻醉在老年下肢骨折手术患者中具有显著的应用效果,不仅起效快速,且安全性佳,值得临床推广。

Objective To explore the application of low-dose light specific gravity spinal anesthesia combined with epidural anesthesia in elderly patients with lower limb fracture surgery.Methods 82 elderly patients with lower extremity fractures who underwent surgical treatment in the hospital from September 2018 to September 2019 were selected and divided into two groups by random number table method,that is,41 cases in the control group and the study group each.The control group was treated with continuous epidural anesthesia,and the study group was treated with low-dose anesthesia combined with spinal anesthesia.The onset of sensory block onset time,duration of anesthesia maintenance,improved lower limb motion block score(Bromage),and complications of ane sthesia were compared between the two groups.Results The onset time of sensory block in the study group(1.5±1.0)min was lower than that in the control group(2.1±0.5)min(t=3.436,P<0.01),and the Bromage score(0.8±0.2)points was lower than the control group(1.6±0.3)points(t=14.207,P<0.01).There was no significant difference between the anesthesia maintenance time(179.3±16.5)min in the study group and the control group(180.3±14.6)min(t=0.291,P>0.05).The incidence of anesthesia-related complications in the study group was 2.44%lower than that in the control group 19.51%(χ^2=6.116,P<0.05).Conclusion Low-dose light specific gravity spinal anesthesia combined with epidural anesthesia has a significant application effec t in elderly patients with lower extremity fracture surgery.It not only has a rapid onset of action,but also has good safety.