两种不同麻醉方式用于老年人髋关节置换术的临床观察

Two Different Ways of Anesthesia for Elderly Patients in Hip Replacement

目的比较腰硬联合麻醉及气管插管全凭静脉全身麻醉用于老年病人髋关节置换手术的临床观察,为该类病人的临床麻醉选择提供参考.方法选择ASAⅠ～Ⅲ级行髋关节置换手术患者42例,随机分为腰硬联合麻醉组(A组,n=21)和气管插管全凭静脉麻醉全身麻醉组(B组,n=21).观察两组麻醉效果,术中、术后麻醉并发症,记录术前、麻醉诱导时、术中、术毕(B组加拔管时)HR、SBP、DBP的变化.结果A组、B组均全部获得完善的麻醉效果,两组比较差异无统计学意义(P>0.05),A组中有2例由于麻醉穿刺失败,改为全身麻醉.术中并发症:两组的SBP和DBP均较麻醉前显著下降(P<0.01),术中出现低血压(血压下降超过基础值的30%)的患者,A组有6例(占30%),B组麻醉诱导时12例(占60%),B组拔管时有4例(占20%)出现血压升高,需用乌拉地尔控制.术后随访3d,两组均未出现不良并发症.结论两种麻醉方式均能满足手术需要,麻醉方式的选择不能照搬教条,需要术前综合评估,术中严密监测,针对两种不同麻醉方式的利弊,因人因时而定.

Objective To provide reference for choice of anesthesia ways in clinic by comparing the effects of combined spinal-epidural anesthesia and general anesthesia with tracheal intubation on elderly patients in hip replacement.Methods Forty-two ASA I～III patients who need to received hip replacement were randomly divided into two groups：combined spinal-epidural anesthesia group（A group,n=21） and general anesthesia with tracheal intubation group（group B,n=21）.The anaesthetic effect,complications,HR,SBP,and DBP of patients during and after operation in the two groups were recorded.Results Patients in both of the two groups got perfect anaesthetic effects,and there was no significant difference（P0.05）.Two patients in A group changed to general anesthesia due to failure of anaesthetic puncture.SBP and DBP of patients during operation in the two groups were lower than before anesthesia（P 0.01）.Hypotension（blood pressure decreased more than 30% of the basic values）was found in 6 patients（30%）during operation in A group,12 patients（60%）after induction of anesthesia in B group.Hypertention was found in 4 patients（20%）when removed the tracheal intubation in B group.All patients werte followed up for 3 days in the two groups and no complications were found.Conclusions Both of the two ways of anesthesia can meet the demand of operation.The choice of anesthesia ways should be based on preoperative evaluation,monitoring in operation,and depends on different patients and conditions.