羟考酮联合蛛网膜下腔麻醉用于高龄病人股骨颈骨折手术的有效性和安全性

Effectiveness and safety of oxycodone combined with intraspinal anesthesia for femoral neck fracture surgery in elderly patients

目的:分析羟考酮联合蛛网膜下腔麻醉用于高龄病人股骨颈骨折手术的有效性及安全性。方法:股骨颈骨折病人40例,按照麻醉方案分为全身麻醉组(C组)21例和羟考酮联合蛛网膜下腔麻醉组(O组)19例。分别于麻醉前(T0)、麻醉后1 h(T1)、缝合时(T3)比较2组病人血流动力学参数[心率(HR)、平均动脉压(MAP)、血氧饱和度]、应激指标[皮质醇(Cor)、去甲肾上腺素(NE)、血管紧张素Ⅱ(AngⅡ)],比较2组病人手术前后视觉模拟评分(VAS),并记录术后并发症发生情况。结果:T0时,2组病人HR、MAP、血氧饱和度差异均无统计学意义(P>0.05);T1、T2时,2组HR和MAP均较T0时明显降低(P<0.01),而O组T1时HR、MAP和T2时MAP均高于C组(P<0.05~P<0.01)。T0时,2组病人血清Cor、NE、AngⅡ水平差异均无统计学意义(P>0.05);T1、T2时,2组血清Cor、NE、AngⅡ水平均较T0时明显升高,而O组T1、T2时血清Cor、NE、AngⅡ水平均明显低于C组(P<0.01)。术前2组病人VAS评分差异无统计学意义(P>0.05);术后6 h,2组病人VAS评分均较术前明显降低(P<0.01),且O组VAS评分明显低于C组(P<0.01)。O组病人恶心呕吐发生率低于C组(P<0.05),2组肺部感染、切口感染、下肢静脉血栓发生率差异均无统计学意义(P>0.05)。结论:与常规静脉全身麻醉相比,高龄病人行股骨颈骨折手术时采用羟考酮联合蛛网膜下腔麻醉在减少循环波动及全身应激损伤、增强术后镇痛作用、减少术后并发症方面均更具优势。

Objective:To analyze the effectiveness and safety of oxycodone combined with intraspinal anesthesia for femoral neck fracture surgery in elderly patients.Methods:Forty patients with femoral neck fracture were divided into the general anesthesia group(group C,n=21),and oxycodone combined with subarachnoid anesthesia group(group O,n=19)according to the anesthesia program.The hemodynamic parameters[heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SpO2)],stress indexes[cortisol(Cor),norepinephrine(NE)and angiotensinⅡ(AngⅡ)]before anesthesia(T0),after anesthesia(T1)and during suture(T3)were compared between two groups.The visual analogue score(VAS)before and after operation were compared between two groups,and the occurrence of complications were recorded.Results:At T0,there was no statistical significance in the levels of HR,MAP and SpO2 between two groups(P>0.05).At T1 and T2,the levels of HR and MAP in two groups were significantly lower than those at T0(P<0.01),while the levels of HR and MAP at T1 and MAP level at T1 in group O were higher than those in group C(P<0.05 to P<0.01).At T0,there was no statistical significance in the levels of Cor,NE and AngⅡbetween two groups(P>0.05).At T1 and T2,the serum levels of Cor,NE and AngⅡin two groups significantly increased compared with at T0,while the levels of Cor,NE and AngⅡin group O at T1 and T2 were significantly lower than those in group C(P<0.01).There was no statistical significance in VAS score between two groups before operation(P>0.05).After 6 h of surgery,the VAS scores in two groups were significantly lower than those before operation(P<0.01),and the VAS score in group O was significantly lower than that in group C(P<0.01).The incidence rates of nausea and vomiting in group O were lower than those in group C(P<0.05),and there was no statistical significance in the incidence rates of pulmonary infection,incision infection and lower limb venous thrombosis between two groups(P>0.05).Conclusions:Compared with conventional intravenous general anesthesia,the oxycodone combined with subarachnoid anesthesia is more advantageous in reducing circulatory fluctuation and general stress injury,enhancing postoperative analgesia,and reducing postoperative complications in elderly patients with femoral neck fracture surgery.