全身麻醉与腰硬联合麻醉在老年股骨颈骨折手术中的麻醉效果及安全性对比

A comparative study on the anesthetic effect and safety between general anesthesia and combined spinal-epidural anesthesia in the operation of femoral neck fracture in the elderly

目的分析老年股骨颈骨折手术中运用全身麻醉与腰硬联合麻醉的效果与安全性。方法140例老年股骨颈骨折手术患者,按照入院顺序分为基础麻醉组与联合麻醉组,每组70例。基础麻醉组采用全身麻醉,联合麻醉组采用腰硬联合麻醉。对比两组血流动力学指标、麻醉效果、麻醉安全性。结果麻醉前,两组患者心率、收缩压对比差异无统计学意义(P>0.05);麻醉后1、2、3 h,联合麻醉组患者心率、收缩压与本组麻醉前对比差异无统计学意义(P>0.05);麻醉后1、2、3 h,基础麻醉组患者心率、收缩压均低于本组麻醉前,且低于联合麻醉组,差异具有统计学意义(P<0.05)。联合麻醉组患者感觉阻滞生成时间(14.84±3.72)min、运动阻滞生成时间(16.80±3.57)min均短于基础麻醉组的(19.26±3.87)、(21.46±4.21)min,感觉阻滞维持时间(271.37±14.60)min、运动阻滞维持时间(130.21±52.98)min长于基础麻醉组的(218.75±12.05)、(83.83±47.28)min,最大感觉阻滞平面(8.89±3.12)高于基础麻醉组的(7.50±3.11),差异具有统计学意义(P<0.05)。手术中、手术后,联合麻醉组不良反应发生率低于基础麻醉组,差异具有统计学意义(χ^(2)=4.155、4.516,P<0.05)。结论全身麻醉与腰硬联合麻醉在老年股骨颈骨折手术中的麻醉效果均较好,但腰硬联合麻醉对患者血流动力学指标的影响较小,患者不良反应发生率低,安全性更高,因此临床上首选腰硬联合麻醉。

Objective To analyze the effect and safety between general anesthesia and combined spinalepidural anesthesia in the operation of femoral neck fracture in the elderly.Methods A total of 140 elderly patients with femoral neck fracture operation were divided into the basic anesthesia group and the combined anesthesia group according to the admission order,with 70 cases in each group.General anesthesia was used in the basic anesthesia group and combined spinal-epidural anesthesia was used in the combined anesthesia group.The hemodynamic index,anesthetic effect and anesthetic safety were compared between the two groups.Results Before anesthesia,there was no statistically significant difference in heart rate and systolic blood pressure between the two groups(P>0.05).At 1,2 and 3 h after anesthesia,the differences in heart rate and systolic blood pressure of patients in the combined anesthesia group were not statistically significant compared with those before anesthesia in this group(P>0.05).At 1,2 and 3 h after anesthesia,the heart rate and systolic blood pressure of patients in the basic anesthesia group were lower than those before anesthesia in this group,and lower than those in the combined anesthesia group.All the differences were statistically significant(P<0.05).The patients in the combined anesthesia group had shorter sensory block generation time(14.84±3.72)min and motor block generation time(16.80±3.57)min than(19.26±3.87)and(21.46±4.21)min in the basic anesthesia group,and the sensory block maintenance time(271.37±14.60)min and motor block maintenance time(130.21±52.98)min was longer than(218.75±12.05)and(83.83±47.28)min of the basic anesthesia group,and the maximum sensory block plane(8.89±3.12)was higher than(7.50±3.11)of the basic anesthesia group.All the difference was statistically significant(P<0.05).During and after operation,the incidence of adverse reactions in the combined anesthesia group was lower than that in the basic anesthesia group,and the difference was statistically significant(χ^(2)=4.155,4.516;P<0.05).Conclusion Both general anesthesia and combined spinal-epidural anesthesia have better anesthesia effects in elderly femoral neck fracture surgery,but combined spinal-epidural anesthesia has less impact on patients'hemodynamic indexes,lower incidence of adverse reactions,and higher safety,so combined lumbar and rigid anesthesia is preferred clinically.