硬膜外麻醉结合静—吸复合浅全麻老年人股骨头置换术76例分析

Combination of Epideral Anesthesia and Static-absorption Compound Shallow Anesthesia Among 76 Elder Femoral Head Anthroplasty Cases

目的探讨硬膜外麻醉结合静-吸复合浅全麻用于老年人股骨头置换术的可行性。方法回顾雅安市中医医院麻醉科2005-04/2008-04老年人股骨头置换术76例的临床资料。结果76例患者麻醉平稳,18例患者在注入骨水泥后血压心率下降20%左右,经简单处理很快得以纠正,58例患者生命体征及脉搏血氧饱和度均正常、平稳;术前合并糖尿病或高血压者,术中未行降糖或降压处理;房颤患者,术中未使用抗心律失常药物,心率控制在80100次/min左右;术中所有患者肌肉松弛,手术用时120～180min,术毕5～10min患者苏醒拔除气管导管,行硬膜外自控镇痛(PCEA)。术后2d随访,无硬膜外麻醉及浅全麻并发症。结论硬膜外麻醉结合静-吸复合浅全麻用于老年人股骨头置换术,镇痛镇静完善、呼吸循环稳定、快速苏醒,减少术后并发症。该法临床麻醉效果好,适宜于老年人股骨头置换术。

Objective To explore the feasibility of combination of epidural anesthesia static-absorption compound shallow anesthesia among elderly femoral head arthroplasty cases.Method No hypoglycemic or hypotensor freatment was made to cases complicated with diabetes or hypertention before operation.The clinical data of 76 relevant cases collected from 2005-04/2008-04 in author's hospital were retrospectively analysed.Results The anesthesia of all 76 cases was smooth.After injection of bone cement,the blood pressure and heart rate decreased about 20% in 18 cases,but all of them returned to normal after simple treatment.In the remaining 58 cases,the vital signs,blood oxygen saturation and pulse were normal and smooth.No hypoglycemic or hypotensor freatment was made to cases complicated with diabetes or hypertention before operation.In atrial fibrillation cases,no anti-arrhythmic drugs were used,and their heart rate remained at 80-100 times /min or so.The musculi of all cases were relaxed during operation.The operation lasted for 120-180 min.The cases awaked 5-10 min after operation,and the tracheal catheter was removed.Parallel-controlled epidural analgesia(PCEA)was then carried out.Follow-up survey was made 2 days after operation and no anesthesia complication was found.Conclusion The combination of epidural anesthesia static-absorption compound shallow anesthesia applied in the femoral head arthroplasty for the elderly,reveals favorable effect in clinical anesthesia.