全身麻醉与腰硬联合麻醉在髋关节置换术中的应用效果对比

Comparison of effects of general anesthesia versus combined spinal-epidural anesthesia on hip replacement

目的比较全身麻醉与腰硬联合麻醉在髋关节置换术中的麻醉效果。方法选择河南科技大学第一附属医院2018年10月至2020年10月收治的行髋关节置换术患者210例,每组105例。根据患者采取麻醉方案不同,分为全身麻醉组和腰硬联合麻醉组。比较全身麻醉组和腰硬联合麻醉组患者的麻醉有效率、并发症发生情况、麻醉起效时间、麻醉药物用量、阻滞完全时间、术后清醒时间,以及全身麻醉组和腰硬联合麻醉组患者麻醉前、麻醉后30 min、麻醉后1 h、手术后的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO2)。结果腰硬联合麻醉组患者麻醉有效率略高于全身麻醉组,但差异未见统计学意义(P>0.05)。全身麻醉组患者麻醉起效时间、阻滞完全时间和术后清醒时间均明显长于腰硬联合麻醉组,麻醉药物用量明显高于腰硬联合麻醉组,差异有统计学意义(P<0.05)。全身麻醉组患者麻醉后30 min、麻醉后1 h的MAP和HR明显高于麻醉前,SpO2明显低于麻醉前,与麻醉前比较,差异有统计学意义(P<0.05)。而腰硬联合麻醉组患者各时间点MAP、HR和SpO2比较,差异未见统计学意义(P>0.05)。腰硬联合麻醉组患者并发症的发生率低于全身麻醉组,差异有统计学意义(P<0.05)。结论与全身麻醉相比,髋关节置换术中应用腰硬联合麻醉具有较好的麻醉效果,麻醉药物用量较少,麻醉起效时间、阻滞完全时间和术后清醒时间较短,且对患者血流动力学的影响较小,安全性较高。

Objective To compare the effects of general anesthesia and combined spinalepidural anesthesia on hip replacement.Methods A total of 210 patients who underwent hip replacement in Kaiyuan Hospital,the First Affiliated Hospital of Henan University of Science and Technology from Oct 2018 to Oct 2020 were included retrospectively.The patients were divided into general anesthesia group and combined spinal-epidural anesthesia group according to different anesthesia schemes.The effective rate of anesthesia,complications,anesthetic onset time,anesthetic dosage,complete block time,postoperative awake time were compared and the mean arterial pressure(MAP),heart rate(HR)and blood oxygen saturation(SpO2)befor anesthesia,30 min after anesthesia and 1 h after anesthesia were compared between the two groups.Results The effective rate of combined spinalepidural anesthesia group was slightly higher than that of general anesthesia group,but there was no significant difference between the two groups(P>0.05).The onset time of anesthesia,complete block time and postoperative awake time of patients in general anesthesia group were significantly longer than those in combined spinal-epidural anesthesia group,and the dosage of narcotic drugs was significantly higher than that in combined spinal-epidural anesthesia group(P<0.05).MAP and HR of patients in general anesthesia group at 30 min after anesthesia and 1 h after anesthesia were significantly higher than those before anesthesia and SpO2 was significantly lower than that before anesthesia(P<0.05).However,there was no significant difference in MAP,HR or SpO2 at each time point in the combined spinal-epidural anesthesia group(P>0.05).The incidence of complications in combined spinalepidural anesthesia group was significantly lower than that in general anesthesia group(P<0.05).Conclusions Compared with general anesthesia,the application of combined spinal-epidural anesthesia in hip replacement has better anesthetic effect,less dosage of anesthetic,shorter onset time of anesthesia,complete block time and postoperative waking time,less influence on hemodynamics of patients,and high safety.