脊椎-硬膜外联合阻滞改良法用于高龄患者膝关节置换术的效果

Effects of Spinal Epidural Block Combined with Modified Method for Knee Joint Replacement in Elderly Patients

目的：本研究旨在探讨改良脊柱-硬膜外联合阻滞麻醉方法应用于高龄膝关节置换手术患者的临床效果。方法：采用随机数字表法将本院骨科2011年7月~2014年12月行膝关节置换患者81例分为观察组（脊柱-硬膜外联合阻滞麻醉）40例和对照组（全身麻醉）41例,对比两组麻醉效果及不良反应差异。结果：观察组和对照组的感觉阻滞起效时间、感觉阻滞恢复时间、运动阻滞起效时间、运动阻滞恢复时间的差异均无统计学意义（P〉0.05）。观察组和对照组的麻醉30min后Bromage评分、优良率差异均无统计学意义（P〉0.05）。观察组与对照组的患者在麻醉前24h的Mo CA评分值异无统计学意义（P〉0.05）,麻醉24h后观察组的Mo CA评分显著的高于对照组（P〈0.05）。结论：改良脊柱-硬膜外联合阻滞麻醉方法与全身麻醉在高龄膝关节置换手术中麻醉效果相当,但是能够有效避免全身麻醉高龄患者术后发生认知功能障碍的缺点。

Objective： This research attainments in discuss improvement of spinal epidural combined anesthesiaanesthesia methods in elderly knee replacement surgery in patients with clinical effect.Methods：81 patients with knee jointreplacement were randomly divided into observation group （40 cases） and control group （41 cases）,two cases were divided intogroups.Results：There was no statistical significance （P〉0.05） in the sensory block onset time,sensory block recovery time,theonset time of sensory block,and the recovery time of motor block in the observation group and the control group . Therewas no significant difference in Bromage score between the observation group and the control group （P〉0.05） after 30min.There was no significant difference （P〉0.05） between the 95.12% and the control group （97.50%）. There was no significantdifference in HR,MAP and RR between the observation group and the control group （P〉0.05）. The MoCA scores of patientsin the observation group and the control group were not statistically significant （24h）,and the MoCA score of the observationgroup was significantly higher than that of the control group （P〈0.05）. Conclusion：Modified spinal epidural block anesthesiaand general anesthesia in elderly patients with knee replacement surgery,but can effectively avoid the postoperative cognitivedysfunction in elderly patients.