全身麻醉与腰-硬联合麻醉在老年骨科手术患者的临床效果比较

Comparison of Effect of with General Anesthesia and Spinal-Epidural Anesthesia in Elderly Patients Undergoing Orthopedics Surgery

目的比较全身麻醉和腰-硬联合麻醉在老年骨科手术患者中的临床应用效果及安全性。方法选择2015年1月至2016年1月北京中医医院顺义医院进行骨科手术治疗的150例患者为研究对象。按照随机数字法将其分为观察组(72例)和对照组(78例)。患者在入院后均进行各项常规检测,并做好术前准备,对照组患者均采用咪达唑仑(0.05~0.10 mg/kg)、依托咪酯(0.2 mg/kg)、芬太尼(3~4μg/kg)和顺苯磺酸阿曲库铵(0.6 mg/kg)静脉注射进行全身麻醉;而观察组患者采用布比卡因重比重液(2 mL 0.5%)进行腰-硬联合麻醉。麻醉后对患者进行骨科手术。观察监测在麻醉穿刺及给予麻醉药物前(T_0)以及麻醉完成后的10 min(T_1)、30 min(T_2)患者的心率、舒张压以及收缩压等血流动力学指标;手术结束1 h后对所有患者的应激指标进行检测;并对两组患者呕吐、神经损伤等不良反应进行统计分析。结果两组在T_1、T_2时的心率、舒张压以及收缩压均较T_0时呈下降趋势,且对照组下降速度更快,两组患者在组间、时点间以及组间·时点间交互作用比较差异统计学意义(P<0.05)。观察组患者手术后1 h的肾上腺素、肾素、血管紧张素以及去甲肾上腺素水平显著低于对照组[(78±10)μg/L比(127±17)μg/L,(2.1±0.3)ng/L比(4.1±0.6)ng/L,(33±4)μg/L比(60±8)μg/L,(90±11)ng/L比(177±21)ng/L](P<0.01)。观察组患者的不良反应发生率显著低于对照组[5.55%(4/72)比16.66%(13/78)](P<0.05)。结论腰-硬联合麻醉能够有效改善老年患者的血流动力学,减弱患者产生的应激反应,并且不良反应发生率低,值得推广使用。

Objective To compare the clinical efficacy and safety of general anesthesia with lumbar-epidural anesthe- sia in elderly patients undergoing orthopedic surgery. Methods From Jan. 2015 to Jan. 2016,150 patients who underwent orthopedic surgery at Shunyi Hospital of Beijing Hospital of Traditional Chinese Medicine, were included in the study. The 150 patients were divided into an observation group（72 cases） and a control group（78 cases） according to the random number method. All the patients were examined routinely after admission, and preoperative preparation was carried out. The patients in the control group were treated with midazolam （0. 05-0. 10 mg/kg）, etomidate （0. 2 mg/kg）, fentanyl （3 to 4 Ixg/kg） and atracurium cis-benzenesulfonate（0. 6 mg/kg） for general anesthesia, while the patients in the observation group were treated with 2 mL 0. 5% bupivacaine for combined spinal-epidural anesthesia. The patients underwent orthopedic surgery after receiving anesthesia. The hemodynamic parameters such as heart rate, diastolic blood pressure and systolic blood pressure were measured in patients with anesthesia and before giving marcotic drugs （ To ） and 10 rain （ T~ ） and 30 min （T2 ） after anesthesia. The stress indexes of all patients were measured at 1 h after the end of operation. The adverse reactions such as vomiting and nerve injury were statistically analyzed in the two groups. Results The heart rate, diastolic blood pressure and systolic blood pressure of the two groups decreased at T, and T2 compared with those at To, and the descent rate was faster in the control group than that in the observation group. The differences between the groups, time points and group · time points were statistically significant （ P 〈 0. 05 ）. The levels of adrenaline, renin, angiotensin and norepinephrine were significantly lower in the observation group than those in the control group[ （78 ± 10） μg/L vs （ 127 ± 17） μg/L, （2. 1 ±0.3） ng/L vs （4. 1±0.6） ng/L,（33 ±4） μg/L vs （60±8） μg/L,（90 ±11） ng/L （177±21） ng/L] （ P 〈 0. 01 ）. The incidence of adverse reactions in the observation group was significantly lower than that in the control group [ 5. 55% （4/72） vs 16. 66% （ 13/78 ） ] （ P 〈 0. 05 ）. Conclusion The combined spinal-epidural anesthesia can improve the hemodynamies and reduce the stress response of the elderly patients, with low adverse reactions incidene, thus is worthy to be popularized.