老年下肢骨折患者并发深静脉血栓的麻醉研究

Anesthesia research on elderly patients with lower limb fractures complicated with deep venous thrombosis

目的探讨老年下肢骨折并发深静脉血栓患者进行手术治疗的麻醉方法。方法选取老年下肢骨折合并深静脉血栓患者100例(血栓致患肢肿痛者除外),随机分为2组:腰硬联合麻醉(CSEA)组和硬膜外麻醉(EA)组。观察记录并比较2组麻醉期间血压、麻醉平面、麻醉诱导时间(椎管内注药至阻滞完善时间)、手术时间、术中补液量、及应用镇痛药和升压药的情况。结果 CSEA组比EA组麻醉诱导时间短、循环稳定、麻醉药和辅助用药量少(P<0.01)。结论小剂量布比卡因CSEA用于老年下肢骨折并发深静脉血栓患者的手术麻醉,效果满意,与EA相比,具有一定的优势。

Objective To investigate the methods of operation anesthesia in elderly patients with lower limb fractures complicated with deep venous thrombosis.Methods 100 elderly patients with lower limb fractures complicated with deep venous thrombosis were enrolled in the study（except those who had pain caused by thrombus）.The patients were randomly divided into combined spinal epidural anesthesia group（CSEA group） and epidural anesthesia group（EA group）.The blood pressure during anesthesia,level of anesthesia,induction time（the time between spinal canal injection and finish of blockade）,operative time,the volume of fluid transfusion and the usage of analgesic and pressor agent were monitored and compared.Results Induction time of CSEA group was shorter than that of EA group,and the circulation of the CSEA group was more stable than that of EA group（P〈0.01）.The dosage of anesthetic and adjuvant drug in CSEA group was less than that in EA group（P〈0.01）.Conclusions In operative anesthesia for elderly patients with lower limb fractures complicated with deep venous thrombosis,the use of small dose of bupivacaine in CSEA has favorable effects and has more advantage compared with EA.