腰麻-硬膜外麻醉在老年患者股骨颈骨折手术中的应用观察

Clinical observation of combined spinal-epidural anesthesia in elderly patients with femoral neck fracture surgery

目的:探讨治疗老年股骨颈骨折手术采用腰硬联合麻醉(combined spinal-epidural anesthesia,CSEA)的临床效果,为临床麻醉提供理论依据。方法:收集本院2014年2至2014年8月股骨颈骨折老年患者74例,随机分为CSEA观察组和全身麻醉组对照组,每组37例。记录患者术中出血量、术后镇痛效果、发生高低血压、肺部感染、缺氧、心动过缓、恶心呕吐、头晕嗜睡比例,测试两组患者对麻醉效果及主刀医师的满意率、肌肉松弛满意率、麻醉优良率、不良反应率、麻醉起效和苏醒时间,对比分析手术效果。结果:观察组低血压发生率高于对照组(18.92%vs.5.41%),而高血压发生率低于对照组(0.00%vs.16.22%),差异有统计学意义(P<0.05)。两组术中出血量、缺氧、心动过缓、麻醉效果及主刀医师满意率比较,差异无统计学意义(P>0.05)。观察组组术后6 h VAS评分、恶心呕吐、头晕嗜睡和肺部感染明显比对照组低,差异有统计学意义(P<0.05)。麻醉优良率(97.30%vs.78.37%)及肌肉松弛满意率(94.59%vs.75.58%)高于对照组,不良反应率低于对照组(5.41%vs.35.14%),麻醉起效和苏醒时间明显早于对照组,差异均有统计学意义(P<0.05)。结论:全身麻醉和CSEA治疗老年股骨颈骨折手术患者,麻醉和术后镇痛效果均较好,而CSEA起效更快、镇痛效果更佳,具有较高安全性和可靠性,苏醒时间早,并发症更少,降低病死率,为手术的顺利实施提供保障,提高康复水平和老年生活质量,值得在临床广泛推广应用。

Objective：To explore clinical effects of combined spinal-epidural anesthesia （CSEA） in elderly patients with femoral neck fracture surgery and provide a theoretical basis for clinical anesthesia. Methods：74 cases of femoral neck fracture in elderly patients were randomly divided into combined spinal-epidnral anesthesia group （ observation group, n = 37） and general anesthesia group（ control group,n = 37） in our hospital from February 2014 to August 2014. The amount of intraoperative blood loss, effects of postoperative analgesia, and occurrence of high and low blood pressure, pulmonary infection, hypoxia, bradycardia, nausea and vomiting, dizziness and drowsiness were recorded. Anesthetic effects of anesthesia, satisfaction rates of surgeon physician, muscle relaxation, anesthesia excellent rate, the rate of adverse reactions, onset time and recovery duration were tested, and operative effects were compared. Results ：The incidence of hypotension in observation group was higher than that in the control group （18.92% vs. 5.41% ） ,while the incidence of high blood pressure lower than that of the control group （0.00% vs. 16.22% ） ,the difference was statistically significant （ P 〈 0.05 ）. Compared the amount of intraoperative blood loss, hypoxia, bradycardia, Anesthetic effects and satisfaction rates of surgeon physician in two groups, the difference was not statistically significant （ P 〉 0. 05 ）. VAS score, nausea and vomiting, dizziness and drowsiness and pulmonary infection at 6 hours after surgery in observation group were significantly lower than those of the control group （P 〈 0.05）. Anesthesia excellent rate （97.30% vs. 78.37% ）, satisfaction rate of muscle relaxation （94.59% vs. 75.58% ） in the observation group were higher than those of the control group, the rate of adverse reactions （5.41% vs. 35.14% ） in observation group lower than that in control group. Onset time and recovery duration of anesthesia in observation group were significantly earlier than those in control group,the difference was statistically significant（ P 〈 0. 05 ）. Conclusion：The effects of anesthesia and postoperative analgesia are good using CSEA or general anesthesia in elderly patients with femoral neck fracture surgery, but the onset time of CSEA is better, with high security and reliability,waking-up earlier,fewer complications and reduced mortality. CSEA provides a guarantee for successful implementation of the operation, improve the level of rehabilitation and the quality of life of the elderly, it is worth to widespread pro- moted use in clinical.