老年患者关节置换术腰硬联合麻醉的量效观察

The dose-effect observation of combined spinal-epidural anesthesia for joint replacement in elderly patients

目的:探讨一种对75岁以上老年患者人工关节置换术能用药少、血压更平稳、更安全有效的麻醉方法。方法:将80例75岁以上接受人工关节置换术的老年患者随机分为硬膜外组(Ⅰ组)、腰-硬联合麻醉组(Ⅱ组)。术中按8～10 ml/(kg.h)输贺斯和复方乳酸钠(1∶1),观察Ⅰ组和Ⅱ组局麻药用量、感觉阻滞起效时间、阻滞平面、阻滞完善时间,同时观察两组的麻醉效果、镇痛效果、血流动力学及不良反应。结果:Ⅱ组感觉阻滞起效时间、阻滞完善时间明显快于Ⅰ组(P<0.01或P<0.05),Ⅱ组麻醉效果优于Ⅰ组(P<0.05)。结论:控制好麻醉平面,术中精心管理,腰-硬联合麻醉用于老年患者人工关节置换术的麻醉是安全有效的。

Objective：To study a kind of less medication,blood pressure more stable,more safe and effective method of anesthesia for patients over 75 years old with prosthetic replacement for joint.Methods：80 elderly patients over 75 years old with prosthetic replacement for joint,were randomly divided into epidural anesthesia group（Ⅰgroup）,combined spinal-epidural anesthesia group（Ⅱgroup）.Intraoperative infusion by 8-10 ml/（kg·h） with compound sodium lactate and HES（1∶1）,in Ⅰgroup and Ⅱgroup local anesthetic dosage,onset time of sensory block,levels of anesthesia and complete block of time were observed,at the same time observed anesthesia effect,analgesic effect,hemodynamics and adverse reactions of two groups.Results：The onset time of sensory block and complete block of time of Ⅱgroup were faster than those of I group（P0.01 or P0.05）,anesthesia effect of Ⅱgroup was better than those of I group（P0.05）.Conclusion：The combined spinal-epidural anesthesia for prosthetic replacement for joint in elderly patients is safe and effective anesthesia,as long as good control of anesthesia and intraoperative careful management.