不同麻醉方式在老年下肢手术中麻醉效果及对术后转归的影响

Effect of Different Anesthesia Methods on Elderly Lower Limb Surgery and Its Effect on Postoperative Outcome

目的探讨不同麻醉方式对接受下肢手术的老年患者的麻醉效果和安全性以及对术中血流动力学变化和术后转归的影响。方法2018年1月—2019年9月,单侧下肢手术的老年患者216例。随机分成组1、组2和组3,各组分别采用神经阻滞麻醉、腰硬联合麻醉和全身麻醉。比较围术期血流动力学变化、术后ICU入住率、治疗满意度及并发症。结果麻醉完成时,组1MAP为(103.84±10.31) mmHg,高于组2(83.11±7.92)mmHg(t=13.508,P=0.000)和组3(82.54±7.82)mm Hg (t=14.132,P=0.000);三组ICU入住率分别为24.00%(18/75),34.29%(24/70),62.00%(45/73),三组间差异有统计学意义(χ2=23.218,P=0.000)。组间两两比较表示,组3分别与组1、组2间的差异具有统计学意义(χ1,32=11.309,P=0.001)、(χ2,32=10.711,P=0.001);三组治疗满意度比较具有统计学意义(F=20.627,P=0.000),组间(t1,2=2.685,P=0.008)、(t1,3=6.552,P=0.000)、(t2,3=2.958,P=0.004)均具有统计学意义(P<0.05);并发症三组间差异有统计学意义(P<0.05)。组1的并发症发生率低于组3(χ21,3=11.254,P=0.001)。结论腰丛和坐骨神经阻滞对伴有重要器官合并症的老年患者行下肢手术是安全有效的,不仅术中血流动力学平稳,还可降低术后ICU入住率和住院时间。

Objective To explore the effect and safety and the influence to the hemodynamic changes and postoperative outcome of different anesthesia methods in gerontal patient in lower extremity surgery.Methods From January 2018 to September 2019,216 elderly patients wth one-sided lower extremity surgery were selected.Divided into group 1;group 2;group 3.Each group was treated with nerve block anesthesia,combined spinal and epidural anesthesia,and general anesthesia.Compared the perioperative hemodynamic changes,ICU occupancy rate,satisfaction and complications.Results When the anesthesia was completed,the MAP of group 1 was(103.84±10.31)mmHg,which was higher than group 2(83.11±7.92)mmHg(t=13.508,P=0.000)and group 3(82.54±7.82)mmHg(t=14.132,P=0.000);ICU occupancy rates of the three groups were 24.00%(18/75),34.29%(24/70),62.00%(45/73),and the difference between the three groups was statistically significant(χ2=23.218,P=0.000).Pairwise comparison between groups indicated that the differences between group 3 and group 1 and group 2 were statistically significant(χ1,32=11.309,P=0.001),(χ2,32=10.711,P=0.001);3 groups of treatment Satisfaction was statistically significant(F=20.627,P=0.000),among groups(t 1,2=2.685,P=0.008),(t 1,3=6.552,P=0.000),(t 2,3=2.958,P=0.004)were statistically significant(P<0.05);the difference between the three groups of complications was statistically significant(P<0.05).The complication rate of group 1 was lower than group 3(χ21,3=11.254,P=0.001).Conclusion Lumbar plexus-sciatic nerve block is effective and safe for gerontal patient accompanied with major organ dysfunction undergoing unilateral lower extremity surgery.It exerts slight influence on hemodynamic stability and reduces ICU occupancy rate and shortens median length of hospital stay.