不同椎管内麻醉方式在高龄病人髋部手术的应用研究

Application study on senility patient operated in coxa with different anaesthesia in vertebra tube

目的比较三种椎管内麻醉方法用于高龄病人髋部手术的麻醉效果和安全性,探讨适合高龄病人髋部手术的椎管内麻醉方式. 方法选择75例拟行髋部手术的高龄病人,随机分成3组,即持续硬膜外麻醉组(CEA组)、腰-硬联合麻醉组(CSEA组)和单侧腰麻复合硬膜外麻醉组(OCSEA组),每组25例.选择L2-3 或L3-4椎间隙为穿刺点,CEA组单纯硬膜外腔给药,CSEA组蛛网膜下腔给药后头向置入硬膜外导管3.5cm备用后立即平卧,OCSEA组蛛网膜下腔给药及头向置入硬膜外导管后仍保持侧卧位10～15min.麻醉平面尽可能控制在T10以下.比较麻醉平面、麻醉效果及血压变化情况. 结果 CSEA组和OCSEA组麻醉效果优于CEA组,CSEA组和OCSEA组的麻醉平面比CEA组更容易控制,OCSEA组的血压更为稳定. 结论小剂量单侧腰麻复合硬膜外麻醉血压变化小,安全有效,更适合高龄病人髋部手术的麻醉.

Objective To compare the effect and safety on senility patient operated in coxa with different anaesthesia in vertebra tube, and discuss aptitude anaesthesia method to senility patient operated in coxa. Methods 75 patients who are operated in coxa are divided into 3 groups： CEA group, CSEA group, OCSEA group. CEA group is injected in L2-3 or L3-4 through epidural space, and CSEA group through subarachnoid space after posting 3.5cm head orientation over the dura mater and lying flatly later, OCSEA group through subarachnoid space after posting 3.5cm head orientation over the dura catheter but lying lateral position later for 10-15min. level of anesthesia is controlled underT10. The level and effect of anesthesia and the change of blood pressure are compared. Results The effect of anesthesia in CSEA group is better than, the level of anesthesia in CSEA group and are better controlled than CEA group, the blood pressure in OCSEA group is more steady than the other groups. Conclusion Small dose single spinal anesthesia and epidural anesthesia is the best anesthesia method to senility patient operated in coxa with blood pressure changed less and more safety.