浅谈腰-硬联合麻醉在老年髋关节置换术中的临床应用价值

目的：探讨分析腰-硬联合麻醉在老年髋关节置换术中的临床应用价值及安全性。方法：选取2011年10月～2013年4月间我科收治的接受髋关节置换术的老年患者30例作为研究对象，术中为其实施腰-硬联合麻醉，同时监测所有患者的麻醉起效时间，最高感觉阻滞平面，麻醉前及麻醉后1min、10min、30min的收缩压(SBP)和舒张压（DBP)，经皮血氧饱和度(SpO2)，心率(HR)，呼吸(RR)，运动神经阻滞情况(Bromage氏评分,BMS)及术后疼痛评分(VAS),并将监测结果及所有患者的临床资料进行回顾性的分析，以评价这种麻醉方法的效果及对患者血流动力学的影响。结果：这30例患者的手术均获得成功，患者的麻醉起效时间平均为(79±20)s，最高感觉阻滞范围为T10～S5。麻醉10min后患者的SBP/DBP与麻醉前相比有所下降，差异显著(P＜0.05)，具有统计学意义。患者在麻醉前后的SpO2均＞95%，BMS及VAS评分分别为(3.3±0.7)分和(16±5)分。结论：腰-硬联合麻醉起效快速，对人体循环波动的影响相对较少，且安全性较高，非常适合应用于老年髋关节置换术。

Objective: To investigate the clinical application value and safety of combined spinal epidural anesthesia in elderly patients with hip replacement. Methods: From 2011 October to 2013 April in our department were underwent hip replacement in elderly patients with 30 cases as the research object, for the implementation of combined spinal epidural anesthesia in the operation, monitoring the onset time of anesthesia in all patients at the same time, the highest level of sensory block, 1min, 10min, 30min systolic pressure before anesthesia and anesthesia drunk (SBP) and diastolic blood pressure (DBP), percutaneous oxygen saturation (SpO2), heart rate (HR), respiration (RR), motor nerve block (Bromage score, BMS) and postoperative pain score (VAS), and the clinical data of monitoring results and all patients were retrospectively analysis on Evaluation of the anesthesia method, and its effect on the hemodynamics in patients with. Results: Of the 30 patients with operation were successful, onset time of anesthesia in patients with an average of (79 ± 20) s, maximum sensory block range is from T10 to S5. Anesthesia decreased in patients with SBP/DBP compared with 10min before anesthesia, significant difference (P < 0.05), with statistical significance. Patients in anesthesia and SpO2 > 95%, BMS and VAS scores were (3.3 ± 0.7) and (16 ± 5)%. Conclusion: Combined spinal epidural anesthesia rapid onset, the influence to the human cycle fluctuations is relatively small, and the safety is high, very suitable for the elderly patients with hip replacement.