两种麻醉方法用于股骨颈骨折的临床麻醉效果对比

The Clinical Anesthesia Effect of Two Anesthesia Methods for the Operation of Femoral Neck Fracture

目的:探究并比较全身麻醉(general anesthesia,GA)和腰-硬联合麻醉(spinal-epidural anesthesia,SEA)两种麻醉方法在股骨颈骨折(femoral neck fracture,FNF)手术中的临床麻醉效果,为临床麻醉医师选择合理麻醉方案提供参考。方法:选择2018年7月-2019年12月本院收治的98例FNF患者为研究对象,依据随机数字表法将其分为试验组和对照组,每组49例。对照组患者采用GA,试验组采用SEA,比较两组的麻醉效果相关指标、血流动力学指标和呼吸状况及不良反应发生情况。结果:试验组麻醉起效时间、阻滞完全时间和苏醒时间均短于对照组,差异均有统计学意义(P<0.05)。两组患者麻醉5 min后和术后10、20、30 min的心指数(CI)均低于麻醉前(P<0.05)。试验组术后各个阶段CI均高于对照组(P<0.05)。两组术后20、30 min的呼吸频率与麻醉前比较,差异均有统计学意义(P<0.05),但组间比较差异均无统计学意义(P>0.05)。试验组不良反应率为6.12%,低于对照组的20.41%,差异有统计学意义(P<0.05)。结论:在FNF患者手术治疗中,SEA较GA更为安全,对患者血流动力学指标影响小,麻醉持续时间较短,同时对呼吸系统干扰小,值得推荐。

Objective:To explore and compare the clinical anesthesia effects of general anesthesia(GA)and spinal-epidural anesthesia(SEA)in the operation of femoral neck fracture(FNF),and to provide reference for clinical anesthesiologists to choose a reasonable anesthesia regimen.Method:A total of 98 patients with FNF admitted to our hospital from July 2018 to December 2019 were selected as the research subjects.According to random number table method,they were divided into experimental group and control group,49 cases in each group.Patients in the control group received GA,and patients in the test group received SEA.Anesthetic effect related indexes,hemodynamic indexes,respiratory status and the incidence of adverse reactions were compared between the two groups.Result:The onset time of anesthesia,complete time of anesthesia block and recovery time in experimental group were shorter than those in control group,the differences were statistically significant(P<0.05).The cardiac index(CI)at 5 min after anesthesia,10 min,20 min and 30 min after operation in the two groups were lower than that before anesthesia(P<0.05).The CI of the experimental group were higher than those of the control group(P<0.05).There were significant differences in respiratory rate at 20 and 30 min after operation between the two groups(P<0.05),but there were no significant differences between the two groups(P>0.05).The adverse reaction rate of the experimental group was 6.12%,lower than 20.41%of the control group,the difference was statistically significant(P<0.05).Conclusion:In surgical treatment of patients with FNF,SEA is safer than GA,with less impact on hemodynamic indexes,shorter duration of anesthesia,and less interference to respiratory system,which is worthy of recommendation.