摘要
目的:研究腰硬联合麻醉用于高龄病人髋部骨折的可行性。方法:60岁以上高龄髋部骨折择期手术192例,ASA分级Ⅱ~Ⅲ级,随机分为两组,试验组为腰硬联合麻醉(CSEA),称Ⅰ组,104例,由于药物选择的不同又分为布比卡因组Ⅰa和左旋布比卡因组Ⅰb;对照组采用硬膜外阻滞麻醉(EA)称Ⅱ组,88例。观察麻醉平面达T10的时间,最高阻滞平面,麻醉用药总量,追加量,镇痛效果,是否辅助用药,及各项生理指标的检测。结果:Ⅰ组阻滞平面达T10所用时间明显短于Ⅱ组(P〈0.05);最高阻滞平面两组无差异;所用麻醉药总量Ⅰ组明显少于Ⅱ组(P〈0.05);Ⅰ组追加量显著少于Ⅱ组(P〈0.05);Ⅰ组镇痛效果全优,Ⅱ组镇痛效果优:79例,良:9例;辅助用药Ⅰ组明显少于Ⅱ组(P〈0.05);收缩压下降〉35%的以Ⅱ组为多,且有显著性差异(P〈0.05)。而此研究中Ⅰa、Ⅰb组无明显差异。结论:腰硬联合麻醉用于高龄髋部骨折的病人是安全可行的。
Objective: To study the feasibility of the combination of spinal with epidural anesthesia for senile hip joint fracture. Methods:Altogether 192 cases of ASA physical status Ⅱ - Ⅲ senile hip joint fracture undergoing selective surgery were randomly divided into two groups. Group Ⅰ .(104 cases) was performed combined spinal--epiduaral analgesia(CSEA). Group Ⅰ. and group Ⅰ b was performed combined spinal-epidural anesthesia with the use of bupivacaine and levobupivacaine in spinal anesthesia respectively. Group Ⅱ (88 cases) was performed epidural anesthesia only. During the induction, the sense blockage effective time to T10 and the maximum sensory spread were observed; the total dosage and the additional dosage of anesthetic drugs was assessed; the anesthesia efficacy was evaluated; if assistant drug was used; the Change of respiration and circulation after anesthesia was monitored. Results. The sense blockage effective time at T10 was significantly shorter in group Ⅰ than that in group Ⅱ (P〈0. 05). There were no significant difference (P〉0, 05) in the maximum sensory spread, The total dosage and the additional dosage of anesthetic drugs were both significantly less in group Ⅰ than that in group Ⅱ ( P〈 0. 05). The anesthesia efficacy was excellent in all cases of group Ⅰ ; 79 cases in group Ⅱ was excellent, 9 cases in group Ⅱ was good. The assistant drugs was significantly less in group Ⅰ than that in group Ⅱ (P〈 0. 05). Group Ⅰ showed less affection to the respiratory and cardiovascular function than group Ⅱ. Conclusion: The combined spinal-epiduaral analgesia(CSEA) is safe, effective and feasible for senile hip joint fracture.
出处
《医学理论与实践》
2007年第6期645-647,共3页
The Journal of Medical Theory and Practice
关键词
腰硬联合麻醉
高龄
髋部骨折
Combined spinal and epidural anesthesia (CSEA) , Senile, Hip joint fracture