腰硬联合麻醉在下肢闭合骨折合并深静脉血栓患者麻醉中的应用效果

Effects of Combined Spinal-Epidural Anesthesia in Patients with Closed Fractures of Lower Limbs Complicated with Deep Vein Thrombosis

目的探讨腰硬联合麻醉在下肢闭合骨折合并深静脉血栓患者麻醉中的应用效果及安全性。方法选取2019年3月至2020年2月鹤壁煤业(集团)有限责任公司总医院收治的84例下肢闭合骨折合并深静脉血栓患者,均接受复位内固定术治疗,根据麻醉方式分为全麻组(42例)和联合麻醉组(42例)。全麻组接受气管插管全麻,联合麻醉组接受腰硬联合麻醉。比较两组镇静效果、恢复室停留时间、不良反应发生率、麻醉前后平均动脉压(MAP)、心率及简易智能精神状态检查量表(MMSE)评分。结果麻醉前以及手术10、30 min及术后10 min两组镇静效果比较,差异无统计学意义(P>0.05)。与全麻组比较,联合麻醉组恢复室停留时间较短,麻醉后MAP较高,心率较慢,麻醉后12、24 h的MMSE评分较高(P<0.05)。联合麻醉组不良反应发生率(2.38%)低于全麻组(19.05%)(P<0.05)。结论腰硬联合麻醉应用于下肢闭合骨折合并深静脉血栓患者具有良好镇静效果,可稳定患者血压、心率,改善认知功能,缩短恢复室停留时间,具有一定安全性。

Objective To investigate the effect of combined spinal-epidural anesthesia in patients with closed fractures of lower limbs complicated with deep vein thrombosis.Methods A total of 84 patients with closed fractures of lower limbs and deep vein thrombosis who were treated in the General Hospital of Hebi Coal Industry(Group)Limited Liability Company from March 2019 to February 2020 were selected.All patients accepted reduction and internal fixation.They were divided into general anesthesia group(42 cases)and combined anesthesia group(42 cases).General anesthesia group accepted general anesthesia for tracheal intubation,and combined anesthesia group accepted combined spinal-epidural anesthesia.The sedation effect,staying time in the recovery room,incidence of adverse reactions,mean arterial pressure(MAP),heart rate,and the score of simple mental state examination scale(MMSE)were compared between the two groups.Results Compared with the general anesthesia group,the stay in the recovery room of the combined anesthesia group was shorter.After anesthesia,the MAP of the combined anesthesia group was higher than that of the general anesthesia group,the heart rate was slower than that of the general anesthesia group,and the scores of MMSE at 12 h and 24 h after anesthesia were higher than those of the general anesthesia group(P<0.05).The incidence of adverse reactions of the combined anesthesia group(2.38%)was lower than that in the general anesthesia group(19.05%)(P<0.05).Conclusion Combined spinal-epidural anesthesia applied to patients with closed lower extremity fractures and deep vein thrombosis can help stabilize blood pressure and heart rate,improve cognitive function,shorten the stay in the recovery room,and has certain security.