蛛网膜下腔麻醉联合硬膜外麻醉在高龄患者股骨头置换术中的应用

Application of combined spinal/epidural anesthesia in elderly patients receiving femoral head replacement

目的观察蛛网膜下腔麻醉联合硬膜外麻醉（腰硬联合麻醉）在高龄患者股骨头置换术中应用的安全性和有效性。方法选择2009年1月至2013年1月于陕西省榆林市第一医院骨科择期行人工股骨头置换术80例患者，采用随机数字表法随机分为腰硬联合麻醉组和硬膜外麻醉组，各40例。分别评定2组患者麻醉效果，记录术侧感觉阻滞起效时间和局部麻醉药物使用剂量，观察记录麻醉后各时点的平均动脉压和心率。结果腰硬联合麻醉组术侧感觉阻滞起效时间（45±14）S明显短于硬膜外麻醉组[（261±57）S]（P〈0．05），腰硬联合麻醉组椎管内左旋布比卡因使用总剂量为（10±4）mg，明显少于硬膜外麻醉组[（86±24）mg]（P〈0．05），腰硬联合麻醉组患者麻醉效果达到优的患者比例90．0％（36例）明显高于硬膜外麻醉组50．0％（20例）（P〈0．05）。结论腰硬联合麻醉用于高龄患者人工股骨头置换术，起效迅速，镇痛完善，是一种较安全有效的麻醉方法。

Objective To observe the safety and effectiveness of combined spinal / epidural anesthesia （CSEA） in elderly patients undergoing femoral head replacement surgery. Methods Totally 80 patients who accepted femoral head replacement in Yan＇an university school of medicine, second affiliated hospital orthopedic from January 2009 to January 2013. They were randomly divided into the CSEA group and epidural anesthesia group with 40 cases in each group. Anesthesia effect was evaluated in 2 groups. The initial acting time sensory block, lo- c, al anesthesia drug dosage, mean arterial pressure and heart rate at each time point were recorded. Results The onset time of sensory block was significantly shorter in CSEA group （45 ± 14）s than in epidural anesthesia group （261 ± 57 ） s （P 〈 0.05 ）. Levobupivacaine dosage was significantly lower in CSEA group （ 10 ± 4） tug than that in epidural an- esthesia group （86 ± 24）nag （P 〈 0. 05 ）. Optimal anesthesia effect was achieved in 36 cases （90.0%） in CSEA group, significantly higher than that in anesthesia group（ 20 cases, 50.0% ） （P 〈 0.05）. Conclusion CSEA is a safe and effective anesthesia method.