蛛网膜下腔阻滞麻醉用于90岁以上老年患者髋部手术的临床观察

Clinical observation of subarachnoid block anesthesia for hip surgery in elderly patients over 90 years of age

目的观察蛛网膜下腔阻滞麻醉用于90岁以上老年患者髋部手术的安全性和临床疗效。方法入选2014年1月至2015年9月在无锡市第三人民医院骨科行手术治疗的90岁以上髋部骨折患者42例,美国麻醉医师协会(ASA)分级Ⅱ级或Ⅲ级,采用蛛网膜下腔阻滞麻醉。收集患者一般资料,记录患者麻醉和手术相关指标。观察患者在入手术室时(T_0)和注入麻醉药物后5 min(T_1)、10 min(T_2)、15 min(T_3)、30 min(T_4)和手术结束时(T_5)的有创收缩压(ISBP)、有创舒张压(IDBP)、平均动脉压(MAP)、心率(HR)和脉搏血氧饱和度(SpO_2),并采用单因素方差分析(one-way ANOVA)进行统计学分析。观察患者有无不良反应及评价麻醉效果。结果 42例患者布比卡因的平均用量为(11.20±1.45)mg,平均手术时间为(58.81±26.16)min,术中平均出血量(114.39±63.05)ml,平均补液量(910.93±210.81)ml。升压药使用者16例,占38.10%。所有患者的麻醉感觉阻滞平面控制在胸10左右,注入麻醉药物后患者无心慌、胸闷、呼吸困难、寒战及恶心、呕吐等不良反应。评价所有患者的麻醉效果均为优。与T_0时比较,患者的ISBP、IDBP、MAP在T_1～T_5时均显著降低,差异具有统计学意义(P均<0.05);与T_0时比较,患者的HR在T_1～T_4时均显著升高,差异具有统计学意义(P均<0.05);与T_0时比较,患者的SpO_2在T_1～T_5时均显著升高,差异具有统计学意义(P均<0.01)。结论蛛网膜下腔阻滞麻醉用于90岁以上老年患者的髋部手术安全有效。

Objective To observe the safety and clinical efficacy of subarachnoid block anesthesia for hip surgery in elderly patients over 90 years of age.Methods From January 2014 to September 2015,42 patients over 90 years old with hip fracture who underwent surgical treatment at the orthopaedics department of the Third People's Hospital of Wuxi City were enrolled.All patients had ASA classⅡorⅢand underwent subarachnoid block anesthesia.The general information of the patients was collected,and intraoperative indicators were recorded.Invasive systolic blood pressure(ISBP),invasive diastolic blood pressure(IDBP),mean arterial pressure(MAP),heart rate(HR),and pulse oxygen saturation(SpO2)of patients when entering into the operating room(T0),at 5 min(T1),10 min(T2),15 min(T3),and 30 min(T4)after the injection of anesthetics,and at the end of the surgery(T5)were also recorded.One-way ANOVA was used for statistical analysis.The adverse reactions and the effect of anesthesia were also evaluated.Results In the 42 cases,the mean dosage of bupivacaine was(11.20±1.45)mg,the mean operation time was(58.81±26.16)min,the mean blood loss was(114.39±63.05)mL,and the fluid replacement was(910.93±210.81)mL.There were 16 cases of vasopressor users,which accounted for 38.10%of all cases.Sensory block anesthesia was controlled at around the thoracic 10 level in all patients.No adverse reactions such as palpitation,chest tightness,dyspnea,chills,and nausea and vomiting occurred after injection.All the patients obtained excellent results.The ISBP,IDBP,and MAP at T1-T5 were significantly lower than those at T0(P<0.05).The HR at T1-T4 were significantly faster than that at T0(P<0.05).The SpO2 was significantly higher at each time point after injection than at T0(P<0.01).Conclusion Subarachnoid block anesthesia is safe and effective in elderly patients(over 90 years old)undergoing hip surgery.