探讨腰硬联合麻醉在老年人髋关节置换术中的应用与管理

Study on the Application and Management of Combined Spinal and Epidural Anesthesia in the Elderly Patients Undergoing Total Hip Arthroplasty

目的探讨腰硬联合麻醉在老年人髋关节置换术中的应用效果与管理方法。方法选取2015年6月至2017年5月在我院行髋关节置换术的老年患者180例,按照随机数字表法分成观察组和对照组各90例,观察组采用腰硬联合麻醉,对照组采用硬膜外麻醉,比较2组麻醉起效时间、麻醉药用量及麻醉效果,记录麻醉前及麻醉后5min、10min、30min、60min血流动力学和血气指标变化,统计术后不良反应发生情况。结果观察组麻醉起效时间和麻醉药用量显著少于对照组(P<0.05),麻醉成功率显著高于对照组(P<0.05);在MAP、HR上,与对照组比较,观察组麻醉后5min、10min、30min、60min明显下降并趋于稳定;在SpO_2上,与对照组比较,观察组更为稳定;2组均无严重不良反应发生。结论腰硬联合麻醉在老年人髋关节置换术中整体麻醉效果优于硬膜外麻醉,可作为临床首选麻醉方式。

Objective To investigate the effect and management of combined spinal and epidural anesthesia in the elderly patients with hip arthroplasty.Methods A total of 180 elderly patients undergoing total hip arthroplasty from June 2015 to May 2017 were random Ly divided into observation group（n=90） and control group（n=90） according to random number table.The epidural anesthesia was used to compare the onset time of anesthesia,the dosage of anesthetic and the anesthetic effect.The changes of hemodynamics and blood gas indexes before anesthesia and 5 min,10 min,30 min,60 min after anesthesia were recorded,the incidence of postoperative adverse reactions was statistically analyzed.Results The time to onset of anesthesia and the amount of anesthetics in the observation group were significantly less than those in the control group（P0.05）,and the successful rate of anesthesia was significantly higher in the observation group than in the control group（P0.05）.Compared with the control group,Group 5 min,10 min,30 min,60 min after anesthesia significantly decreased and stabilized;The SpO_2,compared with the control group,the observation group was more stable;two groups were no serious adverse reactions.Conclusion The combined spinal and epidural anesthesia is superior to epidural anesthesia in the elderly patients undergoing total hip arthroplasty.It can be used as the first choice of clinical anesthesia.