芬太尼腰麻对老年股骨颈骨折病人血流动力学影响

The Hemodynamic Effect of the Subarachnoid Space Block Anesthesia with Fentanyl on the Old Patients with Femoral Neck Fracture

目的：探讨芬太尼腰麻对老年股骨颈手术血流动力学的影响。方法：ASA分级I～Ⅱ级的40名老年股骨颈骨折患者随机分为两组，选择L2～3。间隙穿刺，一组（B）腰麻使用0．75％布比卡因15mg（2m1）＋10％葡萄糖（1m1），另一组（BF）使用0．75％布比卡因7．5mg＋10％葡萄糖＋芬太尼20μg3ml（各1ml），术中观察并记录病人SBP、DBP、MBP、HR例及麻醉效果，记录麻黄素的使用例数。结果：BF组患者SBP、DBP、MAP、HR和B组相比变化较小（P〈0．05），使用麻黄素的例数也较少（P〈0．05），麻醉效果和B组相比没有明显的变化。结论：在蛛网膜下腔使用20μg芬太尼对老年患者股骨颈手术的血流动力学影响较小，患者循环相对稳定，麻醉效果确切，能提高手术的安全性。

Objective： To evaluate the hemodynamic effect of the subarachnoid space block anesthesia with fentanyl on the older patients with femoral neck fracture. Methods： 40 cases of ASA I ～ II older patients with femoral neck fracture were randomly divided equally into two groups. After the puncture were administered between the L2-3 crevice,group B received 0. 75% bupivacaine（2ml） and 10% glucose（lml）, and group BF received 0. 75% bupivacaine, 10%glueose and fentanyl 20μg（each 1 ml）. The systolic blood pressure, diastolic blood pressure, mean blood pressure, heart rate, the anaesthetic results and the times of the ephedrin used were recorded. Results： There was no significant difference between the two groups in the anaesthetic effects. After the anaesthesia, the systolic blood pressure, the diastolic blood pressure and the mean blood pressure of the group B degraded significantly compared to the group BF, and the times of administrating the ephedrin in group B were more than that in group BF. Conclusion; The subaraehnoid space block anesthesia with 20μg fentanyl has little hemodynamic effect on the aged patients with femoral neck fracture. Their circulation is relative stable, and the anaesthetic effect is precisely. It can be used safely.