两种不同麻醉方法在高龄患者髋关节手术中的应用比较

Compare two different methods of anesthesia during hip operation in elderly patients

目的比较连续腰麻(CSA)和腰-硬联合麻醉(CSE)用于高龄患者髋关节手术不同的临床效应。方法择期高龄髋关节手术患者60例,年龄70～96岁。ASAⅡ～Ⅳ级,随机分为CSA组和CSE组,每组各30例。两组以0.1mL/s速度蛛网膜下腔注入0.5%布比卡因1.0～1.8mL,术中根据手术需要和手术时间长短,维持麻醉期间CSA组蛛网膜下腔追加0.5%布比卡因0.5～1.0mL;CSE组硬膜外腔追加0.5%布比卡因3.0～6.0mL。比较两组患者麻醉后痛觉、运动阻滞的异同,麻醉后血压、心率的变化及有无术后并发症。结果两种麻醉方法均能满足手术需要,CSA组阻滞平面未超过T10,CSE组有9例(30%)阻滞平面超过T10,两组比较差异有显著性(P<0.05);CSE组运动阻滞恢复稍慢,但两组比较差异无显著性(P>0.05)。CSE组麻醉后平均动脉压(MAP)显著降低,MAP的变化与术前及与CSA组各时点比较差异有显著性(P<0.05)。两组术后均未发生并发症。结论 CSA用于高龄患者髋关节手术麻醉效果完善,用药量少,血流动力学稳定,不失为这类患者较好的一种麻醉方法。

Objective To compare different clinical effects of continuous spinal anesthesia（CSA）and combined spinal-epidural anesthesia（CSE） for hip joint operations in the elderly patienrs. Methods Sixty ASA Ⅱ-Ⅳ elderly patients of aged 70 - 96 year scheduled for hip joint operations were randomly divided into CSA group and CSE group（n= 30 each）. Two group received subarachnoid injection with 0.5 % bupivacaine 1.0-1.8mL both at a rate of 0.1 mL/s. Within maintaining anesthesia, according to the operation time and needing,the CSA group received subarachnoid injection 0.5 % bupivacaine in dose of 0.5 -1.0mL, whereas the CSE group received 3.0 - 6.0mL in epidural space. Compare the difference in the level of sensory block and degree of motor block after anesthesia, re- cord MAP, HR and adverse effects after intrathecal injecion. Results The block level does not exceed T10 at CSA group,wheres at CSE group the amounts of exceeding T10 is 9（30%）（ P 〈0. 05）. MAP is significantly low after anesthesia in both group（ P 〈0.05）, lower than before operation and CSE group（ P〈0.05）. No complications were observed after operation. Conclusions Continuous spinal anesthesia used to elderly patients in hip joint operations is efficient, and provides less drug volume, better hemodynamic stability than combined spinal-epidural anesthesia. It is a better anaesthesia method for analogous sufferer.