腰麻硬膜外联合麻醉在老年人股骨头置换术中的应用效果分析

Analysis of the Application Effect of Combined Spinal and Epidural Anesthesia in the Treatment of Femoral Head Replacement in the Elderly

目的探讨老年人股骨头置换术中应用腰麻硬膜外联合麻醉的效果。方法对该院行股骨头置换术治疗的80例老年患者进行分组研究,选取时间为2016年10月—2018年8月,采用随机抽签法均分为两组,即参照组与实验组。参照组40例患者应用硬膜外阻滞麻醉,实验组40例患者应用腰麻硬膜外联合麻醉,统计分析两组患者麻醉情况及生命体征指标水平。结果实验组麻醉起效时间、阻滞完善时间、硬膜外用药剂量分别为(1.95±0.83)min、(7.86±2.64)min、(5.72±2.25)m L,参照组为(5.61±1.55)min、(14.56±4.03)min、(12.45±4.28)mL,组间对比(t=13.165 3、8.795 5、8.802 6,P=0.000 0、0.000 0、0.000 0)。实验组麻醉前、麻醉30 min后舒张压、收缩压、心率分别为(78.83±11.17)mmHg、(76.26±9.35)mmHg、(130.14±17.34)mmHg、(127.18±12.83)mmHg、(77.49±9.12)次/min、(75.75±8.41)次/min,参照组为(77.97±11.54)mmHg、(66.49±9.06)mmHg、(130.79±18.35)mmHg、(115.26±12.17)mmHg、(76.87±9.85)次/min、(66.62±8.83)次/min,组间对比(t=0.338 6、4.746 0、0.162 8、4.263 1、0.292 1、4.735 3,P=0.7357、0.000 0、0.871 0、0.000 0、0.770 9、0.000 0)。实验组麻醉起效时间、阻滞完善时间短于参照组,硬膜外用药剂量少于参照组,差异有统计学意义(P<0.05)。实验组麻醉30 min后舒张压、收缩压、心率高于参照组,差异有统计学意义(P<0.05)。结论老年人股骨头置换术中应用腰麻硬膜外联合麻醉的效果更加显著,且对血压、心率指标水平的影响较小,具有极高的临床应用与推荐价值。

Objective To investigate the effect of combined spinal and epidural anesthesia in femoral head replacement in the elderly.Methods Eighty elderly patients treated with femoral head replacement in our hospital were divided into two groups from October 2016 to August 2018,namely the reference group and the experimental group.40 patients in the reference group were treated with epidural anesthesia,and 40 patients in the experimental group were treated with spinal anesthesia combined with epidural anesthesia.The anesthesia and vital signs were analyzed statistically.Results The time of onset of anesthesia,the time to complete the anesthesia,and the dose of epidural use in the experimental group were(1.95±0.83)min,(7.86±2.64)min,(5.72±2.25)mL,and the reference group was(5.61±1.55)min,(14.56±4.03)min,(12.45±4.28)mL,comparison between groups(t=13.165 3,8.795 5,8.802 6,P=0.000 0,0.000 0,0.000 0).The diastolic blood pressure,systolic blood pressure and heart rate of the experimental group before anesthesia and 30 minutes after anesthesia were(78.83±11.17)mmHg,(76.26±9.35)mmHg,(130.14±17.34)mmHg,(127.18±12.83)mmHg,(77.49±9.12)times/min,(75.75±8.41)times/min,reference group of(77.97±11.54)mmHg,(66.49±9.06)mmHg,(130.79±18.35)mmHg,(115.26±12.17)mmHg,(76.87±9.85)times/min,(66.62±8.83)times/min,comparison between groups(t=0.338 6,4.746 0,0.162 8,4.263 1,0.292 1,4.735 3,P=0.735 7,0.0000,0.871 0,0.000 0,0.770 9,0.000 0).The onset time and block completion time of the experimental group were shorter than that of the reference group,and the dose of epidural use was less than that of the reference group,and the difference was significant(P<0.05).After 30 minutes of anesthesia in the experimental group,the diastolic blood pressure,systolic blood pressure and heart rate were higher than the reference group,and the difference was significant(P<0.05).Conclusion The effect of combined spinal and epidural anesthesia in femoral head replacement is more significant,and it has less influence on blood pressure and heart rate index.It has high clinical application and recommendation value.