等比重布比卡因腰麻联合多模式镇痛对老年下肢骨科手术患者加速康复的影响

Effect of isobaric solution bupivacaine for spinal anaesthesia combined with multimode analgesia on accelerated rehabilitation of elderly patients with lower extremity orthopedic surgery

目的观察等比重布比卡因腰麻联合多模式镇痛对老年下肢手术患者早期恢复的影响。方法分析2013～2014年我院行下肢骨科手术的老年患者197例,按不同的麻醉和术后镇痛方法分为4组:等比重布比卡因腰麻组﹑重比重布比卡因腰麻组﹑轻比重布比卡因腰麻组,每组49例,全麻组50例。所有分组都采用多模式镇痛。观察记录各组术中血流动力学变化,术后痛觉评分,留置尿管时间,术后第一﹑二天肢体活动度,术后第一﹑二天切口疼痛评分,术后副作用发生情况。结果等比重腰麻组术中需处理的低血压次数、术后第一日疼痛评分以及术后第一天活动评分低于其他组。所有组别尿管留置时间﹑恶心呕吐情况﹑其他术后并发症之间无统计学差异(P> 0. 05)。结论等比重腰麻联合多模式镇痛可促进老年下肢骨科手术患者的早期恢复。

Objective To observe the effect of isobaric solution bupivacaine combined with multimode analgesia on early recovery of elderly lower extremity surgery. Methods A total of197 elderly patients with lower extremity orthopedic surgery in our hospital from 2013 to 2014 were analyzed. According to different anesthesia and postoperative analgesia,there were 4groups: isobaric solution bupivacaine spinal anesthesia group,hyperbaric bupivacaine spinal anesthesia group and the light specific bupivacaine spinal anesthesia group,49 cases in each group,and 50 cases in general anesthesia group. All groups were treated with multimode analgesia. The hemodynamic changes in each group,postoperative pain sensation score,time of indwelling catheter,limb mobility in the first and the second day after surgery,incision pain score on the first and second day after surgery were observed and recorded. Results In isotonic anesthesia group,the times of hypotensions to be treated during the surgery,the pain score and the activity score in the first day after surgery were lower than other groups. There were no significant differences in catheter indwelling time,nausea and vomiting,and other postoperative complications in all groups. Conclusion Equal-weight lumbar anesthesia combined with multimodal analgesia can improve the early recovery of elderly patients with lower extremity orthopedic surgery.