髋关节置换术中全麻和腰硬联合麻醉的应用效果分析

Effect on the application of general anesthesia and combined spinal-epidural anesthesia used in hip arthroplasty

目的探讨全麻和腰硬联合麻醉用于髋关节置换术的麻醉效果。方法 92例行髋关节置换术的患者随机分为观察组和对照组各46例。对照组采用全身麻醉,观察组采用腰硬联合麻醉。比较两组的麻醉效果、不同时间点的血流动力学变化、术后疼痛和并发症发生情况。结果两组患者麻醉效果的优良率无显著差异(P>0.05);与对照组相比较,观察组的麻醉药用量、起效时间、阻滞完全时间和术后患者的清醒时间显著缩短,组间比较差异具有统计学意义(P<0.05);与对照组相比较,观察组麻醉诱导后、插管后即刻、切皮时、拔管时的收缩压、舒张压和心率均显著升高,组间比较差异具有统计学意义(P<0.05);观察组术后疼痛程度和术后并发症的发生率均显著低于对照组,差异具有统计学意义(P<0.05)。结论在髋关节置换术中采取联合腰硬联合麻醉,具有起效快、麻醉效果好、患者血流动力学稳定、术后并发症少等特点,值得在临床推广应用。

Objective To explore the effect of application of general anesthesia and combined spinal - epidural anesthesia in hip arthroplasty. Methods A total of 92 patients with hip arthroplasty were randomly divided into two groups, 46 cases in each group. Patients in control group were given with general anesthesia, and patients in trial group were given with combined spinal - epidural anesthesia. The anesthetic effect, hemodynamic indexes at different time points, postoperative pain and complications were compared between these 2 groups. Results There was no significant difference in excellent rate of anesthesia between these two groups （ P 〈 0.05 ）. The dosage of anesthesia, onset time of sensory block, complete block time and postoperative recovery time of patients in trial group were significantly lower than those of patients in control group （ all P 〈 0.05 ）. The systolic blood pressure, diastolic blood pressure and heart rate of patients in trial group at the point of post - induction, immediate post - intubation, skin cut and time for extubation were significantly higher than those of control group （ all P 〈 0.05 ）. The degree of postoperative pain and complications in trial group were significantly lower than those of control group （ P 〈 0.05 ）. Conclusion Combined spinal - epidural anesthesia used in hip arthroplasty is effective and fast, patients have stable hemodynamic indexes, conducive postoperative analgesia and reduced postoperative complications, hence it is worthy to be applied in clinical practice.