腰-硬联合麻醉与全身麻醉在老年下肢骨折手术患者中的疗效对比

Comparison of the Efficacy of Combined Spinal-epidural Anesthesia and General Anesthesia in Elderly Patients Undergoing Lower Limb Fracture Surgery

目的研究比较腰-硬联合麻醉与全身麻醉在老年下肢骨折手术患者麻醉过程中对患者心率、血压和血氧饱和度的影响。方法选择2017年1月至2019年6月在我院行手术治疗的63例≥60岁老年下肢骨折患者为研究对象,根据患者自愿原则将其分为两组,观察组患者29例,采用腰-硬联合麻醉,对照组患者34例,采用全身麻醉。观察比较两组患者麻醉前、麻醉后30 min、手术结束时的心率、血压和血氧饱和度情况、手术情况及并发症率。结果两组患者麻醉前心率、血压和血氧饱和度均无差异;麻醉30 min后观察组患者心率、血压下降程度低于对照组,血氧饱和度无差异;手术结束时观察组患者心率、血压变化程度低于对照组,血氧饱和度无差异;两组手术时间、术中失血量及术前、术后VAS评分无统计学意义(P>0.05);观察组并发症率为5.88%,低于对照组23.53%,两组差异有统计学意义(P<0.05)。结论由于老年人身体功能和自我修复能力下降,全身麻醉不仅会影响老年患者的呼吸系统,改变血流动力学,而且药物残留时间长,增加并发症的发生。腰-硬联合麻醉药物起效快,感觉与运动神经阻滞作用好,阵痛效果显著,麻醉过程更加稳定,并发症少,适合老年下肢骨折手术患者应用。

Objective To study and compare the effects of combined spinal-epidural anesthesia and general anesthesia on heart rate,blood pressure and blood oxygen saturation in elderly patients undergoing surgery for lower limb fractures.Method Sixty-three cases of elderly patients with lower limb fractures≥60 years old who underwent surgical treatment in our hospital from January 2017 to June 2019 were selected as the research objects.They were divided into two groups according to the principle of patient voluntariness.There were 29 patients in the observation group.Combined spinal-epidural anesthesia,34 patients in the control group received general anesthesia.Observe and compare the heart rate,blood pressure and blood oxygen saturation of the two groups before anesthesia,30 minutes after anesthesia,and at the end of the operation,the operation status and the complication rate.Results There was no difference in heart rate,blood pressure and blood oxygen saturation between the two groups of patients before anesthesia;30 minutes after anesthesia in the observation group,the decrease in heart rate and blood pressure was lower than that in the control group,and there was no difference in blood oxygen saturation.At the end of the operation,the changes in heart rate and blood pressure of the observation group were lower than those of the control group,and there was no difference in blood oxygen saturation.The operation time,intraoperative blood loss,and preoperative and postoperative VAS scores of the two groups were not statistically significant(P>0.05).The complication rate in the observation group was 5.88%,23.53%lower than the control group,the difference between the two groups was statistically significant(P<0.05).Conclusion The physical function and self-repair ability of the elderly are decreased.General anesthesia will not only affect the respiratory system of elderly patients,change the hemodynamics,but also have a long drug residue time and increase the occurrence of complications.The combined lumbar-epidural anesthetics has a quick effect,good sensory and motor nerve block effect,significant pain effects,more stable anesthesia process,and fewer complications.It is suitable for elderly patients with lower limb fracture surgery.