不同麻醉方法对老年人髋关节手术的临床效果对比

Comparison on clinical effect of different anesthesia methods for hip arthroplasty in elderly

目的探索不同麻醉方法用于老年髋关节手术中的效果。方法 60例老年髋关节手术患者为研究对象,根据麻醉方法的不同分为A组(全身麻醉)、B组(蛛网膜下腔阻滞联合硬膜外麻醉)和C组(硬膜外麻醉),每组20例,对比三组患者不同时间点[麻醉前(T0)、切皮前1 min(T1)、扩髓时(T2)、骨水泥灌注后(T3)和手术结束时(T4)]的平均动脉压(MAP)、心率(HR)值及术后苏醒时间。结果在MAP值上,B组患者的波动最小,A组患者的波动最大,T1、T2时三组MAP值比较差异具有统计学意义(P<0.05);在HR值上,B组患者的波动最小,T1、T2时三组HR值比较差异具有统计学意义(P<0.05)。B组和C组患者术后苏醒时间[(5.2±1.0)、(5.9±1.3)h]均短于A组(20.3±4.3)h,差异均具有统计学意义(P<0.05)。结论在老年髋关节手术麻醉中,蛛网膜下腔阻滞联合硬膜外麻醉效果确切,对患者的血流动力学影响小,且患者术后苏醒快,有助于患者术后的康复,值得在临床麻醉中推广应用。

Objective To explore the effect of different anesthesia methods applied in hip arthroplasty in elderly. Methods A total of 60 elderly patients with hip arthroplasty as study subjects were divided by different anesthesia methods into group A（receiving general anesthesia）, group B（receiving subarachnoid anesthesia combined with epidural anesthesia） and group C（receiving epidural anesthesia）, with 20 cases in each group. Comparison were made on mean arterial pressure（MAP）, heart rate（HR） value and postoperative wake-up time at different time points [before anesthesia（T0）, 1 min before skin incision（T1）, reaming（T2）, after bone cement perfusion（T3） and at the end of the surgery（T4）] in three groups. Results Group B had minimum fluctuate, and group A had maximum fluctuate in MAP value. Three groups had statistically significant difference in MAP value at T1 and T2（P〈0.05）. Group B had minimum fluctuate, and group A had maximum fluctuate in HR value. Three groups had statistically significant difference in HR value at T1 and T2（P〈0.05）. Group B and group C had shorter postoperative wake-up time [（5.2±1.0） and（5.9±1.3） h] than（20.3±4.3） h in group A, and the difference had statistical significance（P〈0.05）. Conclusion In anesthesia of hip arthroplasty in elderly, combination of subarachnoid anesthesia and epidural anesthesia shows affirmative anesthesia effect with small effect on hemodynamics in patients and fast postoperative revival, and it also is helpful for postoperative recovery of patients. So it is worth promotion and application in clinical anesthesia.