下肢神经阻滞对高龄髋关节手术患者血流动力学的影响

Effect of lower extremity nerve blocks on hemodynamics of elder patients undergoing hip joint surgery

目的比较下肢神经阻滞和硬膜外麻醉对高龄髋关节手术患者血流动力学的影响。方法择期高龄行髋部手术的患者40例随机均分为腰丛-坐骨神经-椎旁神经阻滞(A组)和硬膜外麻醉(B组)。记录麻醉前(T0)、麻醉给药后10min(T1)、20min(T2)、30min(T3)和60min(T4)的收缩压(SBP)、舒张压(DBP)、HR、心输出量(CO)和体循环阻力(SVR)。结果 A组SBP、DBP、HR、CO和SVR各时间点均无统计学差异(P>0.05)。B组T2-T4的SBP和DBP低于T0(P<0.05);B组T3时的CO为(3.52±0.78)L/min,低于T0时的(4.30±1.30)L/min和A组T3时的(4.28±0.89)L/min(P<0.05)。结论下肢神经阻滞对高龄患者髋关节手术的血流动力学影响较硬膜外麻醉小。

Objective To compare the effect of lower extremity nerve blocks with epidural anesthesia on the hemodynamics of elder patients undergoing hip joint surgery. Methods Forty aged patients scheduled for hip joint surgery were equally randomized into two groups of A（under lumber plexus-sciatic nerve-paravertehral nerve blocks） and B （under epidural anesthesia）. Systolic blood pressure（SBP）, diastolic blood pressure （DBP）, heart rate （HR）, cardiac output （CO） and systemic vascular resistance（SVR） were measured before anesthesia（T0）, at 10 minutes（T1）,20 minutes（T2）, 30 minutes（T3） and 60 minutes（T4） after administratin of local anesthetics. Results SBP,DBP, HR, CO and SVR were not significantly different among 5 time points（P〉0. 05）. SBP and DBP at T2-T4 were lower in group B than those at T0（P〈0. 05）. CO at T3 was （3.52±0. 78） L/min in group B, which was lower than （4.30±1.30） L/min at TO and （4. 28±0.89） L/min in group A（P〈0. 05）. Conclusion Lower extremity nerve blocks have less effect on the hemodynamics than epidural anesthesia in aged patients undergoing hip joint surgery.