腰-硬联合麻醉及全身麻醉应用于老年股骨颈骨折手术的效果

The effect of combined lumbar epidural anesthesia and general anesthesia in the elderly patients with femoral neck fracture and its effect on cognitive function and complications

目的分析全身麻醉和腰-硬联合麻醉两种方法应用于老年股骨颈骨折手术的临床效果及安全性。方法采用随机数字表法将我院91例老年股骨颈骨折手术患者分组,对照组45例应用全身麻醉,观察组46例应用腰-硬联合麻醉,对比两组患者麻醉后的起效时间、完全清醒时间、意识恢复时间、血液动力学变化、认知功能、疼痛及并发症发生率。结果观察组麻醉起效时间、术后意识恢复时间及完全清醒时间均低于对照组,T1与T2时间段HR,MAP,SpO_2水平均高于对照组,麻醉后24小时MMS评分高于对照组,VAS评分低于对照组,并发症发生率(4.35%)低于对照组(20.00%)(P<0.05)。结论腰-硬联合麻醉能够更为有效地维持老年股骨颈骨折手术患者血流动力学稳定,提高镇痛效果,减少对认知功能的影响,降低并发症发生率,麻醉效果优于全身麻醉。

Objectives To analyze the clinical effect and safety of two methods of general anesthesia and combined lumbar-hard combined anesthesia in the elderly patients with femoral neck fracture. Methods Randomly grouping patients in our hospital 91 cases of elderly patients with femoral neck fracture,45 cases of the control group with general anesthesia,the observation group 46 cases of application of combined spinal epidural anesthesia,the onset time of anesthesia,compared two groups of patients after awake time,consciousness recovery time,blood dynamics,cognitive function,the rate of pain and complications. Results In the observation group,the onset time of anesthesia,postoperative consciousness recovery time and awake time were lower than the control group,T1,HR,MAP,T2 time SpO_2 levels were higher than the control group after anesthesia,24 h MMS score higher than the control group,VAS score lower than the control group,the complication rate was 4. 35% lower than the control group 20%（ P〈0. 05）. Conclusion Combined spinal epidural anesthesia can more effectively maintain hemodynamic stability in elderly patients with femoral neck fracture surgery,improve the analgesic effect,reduce the impact of cognitive function,reduce the incidence of complications,and the anesthetic effect is better than general anesthesia.