高龄股骨颈骨折患者轻比重腰麻联合硬膜外阻滞与全麻对其心肺功能影响对照研究

Hypobaric spinal anesthesia combined epidural block compared with general anesthesia on cardiac and pulmonary function in elderly cases of femoral neck fracture

目的探讨使用轻比重腰麻联合硬膜外阻滞与全身麻醉两种麻醉方法对行髋关节置换术的高龄股骨颈骨折患者心肺功能的影响。方法回顾性分析2015年2月至2016年2月沈阳军区总医院骨科行髋关节置换手术治疗的120例高年股骨颈骨折患者的临床资料,根据麻醉方法不同分为A组和B组,每组各60例患者。A组采用轻比重腰麻醉联合硬膜外阻滞,B组采用全身麻醉,观察所有患者手术过程中的心肺功能变化情况,并比较两组患者术中麻醉效果。结果 A组患者高血压发生率、心动过缓发生率、缺氧发生率均明显低于B组,差异均有统计学意义(P<0.05);而两组患者在低血压发生率方面比较,差异无统计学意义(P>0.05)。A组患者的麻醉起效时间明显短于B组(P<0.05),但两组术后镇痛效果视觉模拟评分、麻醉效果总优良率、肌肉松弛效果总满意率方面比较,差异无统计学意义(P>0.05)。结论腰硬联合麻醉和全身麻醉均具有良好的麻醉效果,对髋关节置换术后均具有良好的镇痛效果,但轻比重腰麻联合硬膜外阻滞对患者心肺功能的影响小于全身麻醉,髋关节置换术围术期可优先考虑使用轻比重腰硬联合麻醉。

Objective To analyze and discuss the effect of cardiopulmonary function of patients with senile femoral neck fracture who underwent hip arthroplasty using hypobaric spinal anesthesia combined with epidural block and general anesthesia.Methods A retrospective study was performed on 120 patients with senile femoral neck fracture who underwent hip arthroplasty from February 2015 to February 2016.Patients were divided into Group A and Group B according to different anesthesia methods,with 60 cases in each group.Patients in Group A were performed hypobaric spinal anesthesia combined with epidural block,and the others in Group B were performed general anesthesia.The cardiopulmonary function changes of patients during the surgery were observed and the anesthesia effects were compared the two groups.Results The incidence of hypertension,bradycardia and anoxia in Group A were significantly lower than those in Group B,and the difference was statistically significant（P 0.05）;the incidence of hypotension between the two groups has no statistically significant difference（P 0.05）.The anesthesia onset time of Group A was significantly shorter than that of Group B,and the difference was statistically significant（P 0.05）;the postoperative analgesic effects in VAS scores,in total good rate and in total satisfaction rate of muscle relaxation had no statistically significant difference（P 0.05）.Conclusion Both of hypobaric spinal anesthesia combined spinal epidural and general anesthesia have good effect,and both of them can achieve a standard analgesic effect.Furthermore,due to the impact of cardiopulmonary function in hypobaric spinal anesthesia combined with epidural block is less than general anesthesia,we should priority use hypobaric spinal anesthesia combined with epidural block in perioperative hip arthroplasty.