单侧腰麻在心血管系统异常高龄患者全髋置换术中的应用

Clinical Study of Unilateral Spinal Anesthesia during Total Hip Joint Replacement in the Elderly with Cardiovascular Abnormality

目的 :评价单侧腰麻在心血管系统异常高龄患者全髋置换术中的效果。方法 :选择 4 8例行人工髋关节置换术、心血管系统异常、ASA ～ 级的高龄患者 ,随机均分为单侧腰麻组 (U SA)、传统腰麻组 (TSA)、硬膜外麻醉组(EA)。监测记录麻醉前后的血压 (BP)、心率 (HR)、脉搏氧饱和度 (Sp O2 )、麻醉效果、维持时间等。结果 :EA组需追加麻醉药 ,总用量高于另两组 ;麻醉后各组患者血压均低于麻醉前 (P<0 .0 5 ) ;麻醉后 5、15、30 min TSA组较 USA组与 EA组血压明显降低 (P<0 .0 1) ,其余时间点变化无统计学意义。结论 :单侧腰麻减少局麻药用量 ,减轻对循环系统影响 ,对行人工髋关节置换术、心血管系统异常的高龄患者是一种安全有效的方法。

Objective:To evaluate the effect of unilateral spinal anesthesia during total hip joint replacement in elder patients with cardiovascular abnormality.Methods:Forty-eight patients(age 80～91,ASA II～II, undergoing total hip joint replacement) were randomly divided into three groups: unilateral spinal anesthesia group (USA)、tradition spinal anesthesia group (TSA)、epidural anesthesia group (EA).The vital signs (BP, HR,SpO 2)、blockage level、duration time were recorded.Results:The EA group needed more local anesthetic than the other two groups. The BP of post-anesthesia was lower than that of pre-anesthesia in each group (P<0.05). At 5、15、30 min after-anesthesia, systolic and diastolic pressures of TSA were significantly lower than those of USA and EA (P<0.01),while there was not significantly difference at other time.Conclusion: Unilateral spinal anesthesia could reduce the dose of local anesthetic and diminish the influence to circulation system,so it should be a effective and safe method during total hip joint replacement in the elderly with cardiovascular abnormality.