62例高龄患者髋关节置换术的麻醉管理分析

Analysis of anesthesia managements of 62 elderly patients＇ undergoing hip replacement

目的总结分析高龄患者髋关节置换术的围手术期麻醉管理方法。方法回顾性分析62例行髋关节置换术的高龄（≥75岁）患者的麻醉管理过程及应对措施。结果接受全身麻醉32例，椎管内麻醉30例。手术时间85-434（163±47）min；术中出血量150-1200（454±220）ml。所有手术均顺利完成，术中未观察到合并症，术后苏醒期间合并寒战5例、恶心呕吐3例、顽固性低血压1例，均经积极处理后好转，大部分患者接受术后自控镇痛，镇痛效果良好，无伤残或死亡发生。结论高龄患者行髋关节置换术，创伤大、出血量多、麻醉风险大，应进行详细的术前评估，选择合适的麻醉方式并完善术中监测，积极预防和应对各种并发症。

Objective To summarize and analyze elderly patients＇ anesthesia managements of hip replacement. Methods The anesthesia managements of 62 elderly patients （ ≥ 75 years） undergoing hip replacement were analyzed retrospectively. Results Thirty-two cases received general anesthesia and the other 30 cases were undergone intraspinal anesthesia. The duration of the surgery was 85 - 434 （ 163 ± 47） rain and volume of intraoperative bleeding was 150 - 1 200（454 ± 220） ml. All anesthesia managements were performed safely without complications during operation. But there were 5 patients suffered from shivering, 3 patients suffered from nausea and vomiting and 1 patient got refractory hypotension postoperatively,which were all improved after positive intervention. Most patients were received patient-controlled analgesia with satisfied results. There was no patient dying from complications. Conclusions It＇s a challenging task to manage elderly patients＇ anesthesia for hip replacement, due to its excessive surgical field and massive bleeding. Careful preoperative evaluation and close intraoperative maintenance are essential to decrease both morbidity and mortality of certain complications.