三种麻醉方法在高龄患者全髋置换术中应用的比较研究

Application of Three Anesthesia Methods in Total Hip Replacement Surgery for Aged Patients

目的比较腰-硬联合麻醉、硬膜外麻醉与全身麻醉在高龄患者全髋关节置换术中的临床应用.方法 80岁以上行单侧全髋关节置换术患者60例,随机分为两组:A组(腰-硬联合麻醉组,n=20),B组(硬膜外麻醉组n=20),C组(全身麻醉组,n=20),观察三组患者术中血流动力学变化,记录术中镇静药、升压药、降压药使用率及麻醉起效时间、手术时间、苏醒时间、在PACU停留时间.结果三组患者血流动力学变化差异无统计学意义(P>0.05);苏醒时间、PACU停留时间C组明显长于A组(P<0.01),B组PACU停留时间也长于A组(P<0.05);术中C组使用镇静药、升压药、降压药例数明显多于A组(P<0.05),B组使用镇静药例数也明显多于A组(P<0.05).结论与硬膜外麻醉和全身麻醉相比,腰-硬联合麻醉具有一定的优势,更适用于高龄患者全髋关节置换术.

Objective To compare the clinical application of combined spinal-epidural anesthesia,epidu-ral anesthesia and general anesthesia in total hip replacement surgery for aged patients.Methods 60 aged pa-tients（80 years old） with one-side total hip replacement surgery were randomly divided in to 3 groups：group A（combined spinal-epidural anesthesia n=20）;group B（epidural anesthesia n=20）;group C（general anesthesia n=20） .The changes of hemodynamics,the rate of use of sedative,hypertensive,hypotensive a-gents,and the onset of anesthesia,operation,awake,PACU stay time were recorded respectively.Results The changes of hemodynamics had no significantly difference among the three groups;the awake and PACU stay time of group C was longer than that of group A（P0.01） ,the PACU stay time of group B was longer than that of group A（P0.05） also,the rate of use of sedative,hypertensive,hypotensive agent of group C was higher than that of group A during operation,the rate of use of sedative agent of group B was higher than that of group A also. Conclusion Compared with epidural anesthesia and general anesthesia,combined spinal-epidural anesthesia is more convenient for aged patients with total hip replacement surgery.