老年全髋置换术患者在不同体位下行腰硬联合阻滞麻醉后血流动力学变化

Elderly patients with total hip replacement in different position downward hemodynamic changes after the combined spinal-epidural anesthesia

目的：观察不同体位的腰硬联合阻滞麻醉在老年患者全髋置换术中的血流动力学变化。方法将择期行全髋置换术的老年患者80例随机分为腰硬联合阻滞麻醉卧位组（P组）和腰硬联合阻滞麻醉坐位组（S组）,每组40例进行手术。P组于蛛网膜下腔在卧位时给予0.5%布比卡因10 mg，S组则在坐位时给予同样剂量并保持此体位1 min。观察两组麻醉阻滞平面及麻醉前、后血流动力学变化。结果 S组平均动脉压（MAP）在各时点较P组明显增高，两组心率变化无明显差异，S组血流动力学较P组稳定。两组阻滞平面在给药后20 min差异无统计学意义。结论腰硬联合阻滞麻醉时采取坐位对于老年患者全髋置换术血流动力学影响更小，更为安全有效。

ObjectiveThis thesis aims to observe the application of combined spinal-epidural anesthesia in different position in total hip arthroplasty of old age patients.MethodsThis thesis use the method of scheduled total hip joint replacement of old age patients with spinal-epidural anesthesia. Eighty patients scheduled for surgery were randomized to assume P group which remained prone position immediately after 10mg 0.5% bupivacaine were injected and S group which remained in the sitting position for 1 minutes after administrating bupivacaine. We observed the changes of hemodymamics and sensory block levels before and after anesthesia between the two groups. Analgesic levels were assessed bilaterally, using pin-prick.The mean arterial pressure and heart rate were also recorded.ResultsSensory block levels were significantly lower at all time points in S group within 20min. There was no significant difference between two groups after 20 min. And the MAP was significantly lower at all time points in P group. However, there were no significant differences in the heart rate changes between the two groups.ConclusionWe concluded that performing a spinal anesthesia in sitting position was technically safer, effective and induced less hypotension in old age patient''s application of total hip arthroplasty.