硬膜外与硬腰联合麻醉在老年股骨颈骨折手术中的麻醉效果及对患者血液动力学的影响

Comparison of the effects of epidural anesthesia with spinal-epidural anesthesia in the operation of femoral neck fracture and the influence on hemodynamics in elderly

目的探讨硬膜外与硬腰联合麻醉在老年股骨颈骨折手术中的麻醉效果及对患者血液动力学的影响。方法选择股骨颈骨折老年患者90例作为研究对象,按照数字列表法随机分为观察组和对照组,各45例,对照组采用硬膜外麻醉,观察组采用硬腰联合麻醉,比较2组麻醉效果,包括最大感觉阻滞平面、感觉阻滞起效时间、最大感觉阻滞时间、感觉阻滞持续时间、运动阻滞起效时间、最大运动阻滞时间与运动阻滞持续时间,以及血流动力学情况,包括中心静脉压、心率、收缩压与舒张压。结果 (1)观察组患者最大感觉阻滞平面较对照组大,最大感觉阻滞时间、感觉阻滞持续时间及运动阻滞持续时间均较对照组长,感觉阻滞起效时间、运动阻滞起效时间、最大运动阻滞时间均较对照组短,2组比较差异有统计学意义(P均<0.05);(2)术中2组患者中心静脉压、心率、舒张压均显著高于术前,术中收缩压显著低于术前(P均<0.05),术中观察组中心静脉压、心率、舒张压显著低于对照组,收缩压显著高于对照组,差异均有统计学意义(P均<0.05)。结论硬腰联合麻醉应用于老年股骨颈骨折手术中的麻醉效果更好,术中血流动力学指标相对稳定,安全可靠。

Objective To explore the effects of epidural anesthesia and spinal-epidural anesthesia in the operation of femoral neck fracture and the influence on hemodynamics in the elderly. Methods Ninety elderly patients with femoral neck fracture were randomly divided into observation group and control group according to random number table,with 45 cases in each group. The patients in control group received epidural anesthesia,while the patients in observation group received spinal-epidural anesthesia. The anesthesia effects,including the maximum sensory block,onset time of sensory block,maximum sensory block time,sensory block duration,onset time of movement block,maximum movement block time and exercise duration,and the hemodynamics parameters including central venous pressure,heart rate,systolic and diastolic blood pressure were detected and compared between the two groups. Results（1） Compared with control group,the biggest feeling block plane was bigger,the maximum sensory block time,duration of sensory block and motor block duration being longer,sensory block working time,onset time of movement block,maximum movement block time being shorter in observation group（ P0. 05）;（2） The central venous pressure,heart rate,and diastolic blood pressure during surgery in two groups were significantly increased,intraoperative systolic blood pressure significantly decreased（ P0. 05）.The central venous pressure,heart rate,and diastolic blood pressure during surgery in observation group were significantly lower while the systolic blood pressure was significantly higher than that in control group（ P0. 05）. Conclusions The anesthesia effects of spinal-epidural anesthesia in the operation of femoral neck fracture in elderly is better, the hemodynamics including central venous pressure,heart rate,systolic and diastolic blood pressure during surgery are relatively stable.