腰硬联合麻醉用于高龄病人髋部骨折的研究

The Study of Combined Spinal and Epidural Anesthesia for Senile Hip Joint Fracture

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.