硬膜外麻醉在高龄老年患者PFNA手术中的应用

Application of epidural anesthesia in PFNA operation for senile advanced age patients

目的评价硬膜外麻醉在高龄老年患者股骨近端防旋髓内钉(PFNA)手术中的应用效果。方法 80例医院骨科收治拟行PFNA的高龄老年患者作为研究对象,选择全身麻醉(全麻)34例纳入对照组,硬膜外麻醉46例纳入观察组。观察两组疗效。结果两组患者30 d内均未见死亡;观察组术后并发症发生率为17.39%,低于对照组的44.12%,差异具有统计学意义(P<0.05);术后72 h,观察组患者C反应蛋白(CRP)为(24.1±6.2)mg/L,血肾上腺素(NE)为(247.4±14.6)pmol/L,血小板(PLT)为(235.6±18.7)×10~9/L,纤维蛋白原(FIB)为(926.4±37.6)g/L;对照组患者CRP为(32.0±6.1)mg/L,NE为(268.0±17.1)pmol/L,PLT为(235.5±16.3)×10~9/L,FIB为(1040.0±45.3)g/L,观察组CRP、FIB高于麻醉前,对照组CRP、NE、FIB高于麻醉前、观察组,差异具有统计学意义(P<0.05)。结论在高龄患者PFNA手术中应用硬膜外麻醉,可降低术后并发症发生风险,应激水平更低。

Objective To evaluate application effect by epidural anesthesia in proximal femoral nail antirotation（PFNA） operation for senile advanced age patients. Methods There were 80 senile advanced age patients in department of orthopedics in need of PFNA as study subjects. 34 cases receiving general anesthesia were taken as control group, and 46 cases receiving epidural anesthesia were taken as observation group. Curative effects were observed in the two groups. Results There was no death case in both groups within 30 d. The observation group had lower incidence of complications as 17.39% than 44.12% in the control group, and their difference had statistical significance（P0.05）. In postoperative 72 h, the observation group had C-reactive protein（CRP） as（24.1±6.2） mg/L, epinephrine（NE） as（247.4±14.6） pmol/L, platelet（PLT） as（235.6±18.7）×10~9/L and fibrinogen（FIB） as（926.4±37.6） g/L. The control group had CRP as（32.0±6.1） mg/L, NE as（268.0±17.1） pmol/L, PLT as（235.5±16.3）×10~9/L, and FIB as（1040.0±45.3） g/L. The observation group had higher CRP and FIB than those before treatment, and the control group had higher CRP, NE and FIB than those before anesthesia and in the observation group. The difference had statistical significance（P0.05）. Conclusion Implement of epidural anesthesia in PFNA operation for senile advanced age patients can reduce risk of postoperative complications with low stress level.