CSEA用于老年髋部骨折手术的麻醉效果及对术后肺部并发症的影响

Anesthesia effects of CSEA in elderly hip fracture surgery and its influence on postoperative pulmonary complications

目的探讨硬膜外联合蛛网膜下腔麻醉(CSEA)用于老年髋部骨折手术的麻醉效果,以及对术后肺部并发症的影响。方法选取2016年8月至2019年8月我院收治的80例老年髋部骨折手术患者为研究对象,用抽签法随机分为观察组和对照组,各40例。对照组患者予以硬膜外麻醉,观察组患者采取CSEA。比较两组患者麻醉效果、麻醉药物使用剂量、药物起效时间、感觉阻滞情况(感觉阻滞起效时间、感觉阻滞完善时间)、运动阻滞情况(改良Bromage评分)、术后肺部并发症等指标差异性。结果观察组患者麻醉优良率高于对照组,麻醉药物剂量低于对照组(P<0.05),观察组患者起效时间、感觉阻滞起效时间、感觉阻滞完善时间均短于对照组(P<0.05),观察组患者改良Bromage评分优于对照组(P<0.05),两组患者术后肺部并发症发生率比较,差异无统计学意义(P>0.05)。结论相比于硬膜外麻醉,CSEA应用于老年髋部骨折手术可达到更好的麻醉效果,且麻醉药物剂量低、起效快,不增加肺部并发症的发生。

Objective To investigate the anesthesia effects of combined spinal-epidural anesthesia(CSEA)in elderly hip fracture surgery and its influence on postoperative pulmonary complications.Methods Totally 80 elderly patients with hip fracture surgery treated in our hospital from August 2016 to August 2019 were selected as the research subjects,and were randomly divided into observation group and control group by lottery,with 40 patients in each group.Patients in control group were given epidural anesthesia while patients in observation group were given CSEA.The anesthesia effects,dosage of anesthesia drugs,onset time of drugs,sensory block(sensory block onset time,sensory block perfection time),motor block(modified Bromage score)and postoperative pulmonary complications were compared between the two groups.Results The rate of excellent and good anesthesia in observation group was higher than that in control group while the dosage of anesthesia drugs was lower(P<0.05);the onset time,sensory block onset time and sensory block perfection time in observation group were shorter than those in control group(P<0.05).The modified Bromage score in observation group was better than that in control group(P<0.05).There was no significant difference in the incidence rate of postoperative pulmonary complications between the two groups(P>0.05).Conclusion Compared with epidural anesthesia,CSEA can achieve better anesthesia effects in elderly hip fracture surgery;it has lower dosage of anesthetics and faster onset,and it does not increase the occurrence of pulmonary complications.