羟考酮联合蛛网膜下腔阻滞在高龄患者股骨粗隆骨折手术中的应用

Application of oxycodone combined subarachnoid block in the elderly patients with femoral trochanter fracture surgery

目的比较高龄患者股骨粗隆骨折手术中羟考酮联合蛛网膜下腔阻滞与静-吸复合全麻的效果。方法择期行股骨粗隆间骨折接受闭合复位股骨近端防旋髓内钉(PFNA)内固定术患者34例,男13例,女21例,年龄76~92岁,ASAⅡ或Ⅲ级,随机分为蛛网膜下腔阻滞联合静脉羟考酮组(O组)和静-吸复合全麻组(C组),每组17例。麻醉前两组均未用术前药,入室后O组静注羟考酮3~5 mg后,蛛网膜下腔给予罗哌卡因12 mg;C组缓慢静注舒芬太尼0.2~0.3μg/kg、顺式阿曲库铵0.15 mg/kg、依托咪酯0.1~0.2 mg/kg诱导,术中泵注丙泊酚3~5 mg·kg^(-1)·h-1、瑞芬太尼0.1~0.3μg·kg^(-1)·min^(-1),吸入0.55%~2%七氟醚维持麻醉,间断静脉注射顺式阿曲库铵0.05~0.10 mg/kg维持肌松。记录住院时间和麻醉相关并发症。结果 O组住院时间明显短于C组[(10.4±1.6)d vs(15.8±2.0)d,P<0.05]。O组的术后恶心呕吐发生率明显低于C组[2例(11.8%)vs 9例(52.9%),P<0.05]。结论在高龄患者PFNA内固定手术中,羟考酮联合蛛网膜下腔阻滞较静-吸复合麻醉提供更佳的效果。

Objective To investigate the advantages and disadvantages of oxycodone combined subaraehnoid block and intravenous-inhalational anesthesia in elderly patients with femoral trochanter fracturethe surgery. Methods Thirty-four patients undergoing elective surgery with closed reduction and Proximal femoral nail anti-rotation （PFNA） fixation, 13 males and 21 females, aged 76-92 years, ASA physical status Ⅱ or Ⅲ, were equally randomized into two groups （n=17 each）： group O and group C. Patients in group O received oxyeodone combined subarachnoid block. Patients in group C received intravenous-inhalational anesthesia. Patients in group C were not premeditated beforel entering the operation room. After entering the rooms group O was given oxycodone 3-5 mg i.v first, then given ropivacaine in subarachnoid space. All patients were induced with intravenous of sulfentanil 0.2-0.3 μg/kg, cisatracurium 0.15 mg/kg, etomidate 0.1-0. 2 mg/kg slowly. Anesthesia was main- tained by intravenous propofol 3-5 mg. kg-1· h-1 , remifentanyl 0. 1-0. 3 μg. kg-1· h-1 , sevofrane 0. 55%-2% infusion, intravenous bolus cisatracurium 0.05 0.10 mg/kg. The anesthesia related com- plications and length of hospital stay were recorded. Results Postoperative nausea and vomiting （PONV） respiratory depression o{ group O was significantly lower than that of group C [2（11.8%） cases vs 9 （52. 9%） cases, P〈0. 05], length of hospital stay of group O was significantly shorter than that of group C [（10.4±1.6） d vs （15.8±2. 0） d, P〈0.05]. Conclusion In the elderly pa- tients with femoral intertrochanteric fracture closed reduction and PFNA internal fixation, oxycodone combined subarachnoid block may improve patients＇ recovery.