腰硬联合麻醉对老年股骨颈骨折手术患者的麻醉阻滞效果及对血流动力学的影响

Effect of combined spinal-epidural anesthesia on elderly patients undergoing femoral neck fracture surgery and its influence on hemodynamics

目的分析腰硬联合麻醉对老年股骨颈骨折(FNF)手术患者的麻醉阻滞效果及对血流动力学的影响。方法抽取中国人民解放军联勤保障部队第九九〇医院2018年2月至2020年1月收治的老年FNF手术患者72例,按随机数字表法分为全身麻醉组与腰硬联合组,每组36例。全身麻醉组采用全身麻醉,腰硬联合组采用腰硬联合麻醉,比较两组麻醉阻滞效果、意识恢复时间、清醒时间、血流动力学指标、简易认知状态评价量表(MMSE)评分、术后1 d视觉模拟评分法(VAS)评分及并发症发生率。结果与全身麻醉组比较,腰硬联合组感觉阻滞和运动阻滞起效时间短,持续时间长(P<0.05);与全身麻醉组比较,腰硬联合组术后意识恢复和清醒时间短(P<0.05)。麻醉后15 min(T1)、麻醉后30 min(T2)、手术结束前(T3),腰硬联合组心率、平均动脉压水平均高于全身麻醉组(P均<0.05)。麻醉后12、36 h,腰硬联合组MMSE评分高于全身麻醉组,术后1 d VAS评分低于全身麻醉组(P<0.05);腰硬联合组并发症发生率(3.13%,1/32)低于全身麻醉组(18.75%,6/32),P<0.05。结论针对老年FNF患者采用腰硬联合麻醉可显著提升麻醉阻滞效果和术后恢复效果,减轻应激反应和术后疼痛,并能降低并发症发生率。

Objective To analyze the effect of combined spinal-epidural anesthesia on elderly patients undergoing femoral neck fracture(FNF)surgery and its influence on hemodynamics.Methods A total of 72 elderly patients with FNF treated in the No.990 Hospital of Joint Logistic Force Army of Chinese People’s Liberation Army from February 2018 to January 2020 were selected.And they were divided into general anesthesia group and combined spinal-epidural group by random number table method,with 36 cases in each group.General anesthesia was used in the general anesthesia group,and combined spinal-epidural anesthesia was used in the combined spinal-epidural anesthesia group.The anesthesia block effect,consciousness recovery time,awake time,hemodynamic indexes,cognitive function score(MMSE),1-day postoperative visual analogue scale(VAS)score,and the incidence of complications were compared between the two groups.Results Compared with the general anesthesia group,the onset time of sensory block and motor block in the combined spinal-epidural group were shorter,while the duration was longer(P<0.05).Compared with the general anesthesia group,the time of consciousness recovery and awake time in the combined spinal-epidural group were shorter(P<0.05).Compared with the general anesthesia group,the heart rate and mean arterial pressure level were higher in the combined spinal-epidural group at 15 min after anesthesia,30 min after anesthesia,and before operation(all P<0.05).Compared with the general anesthesia group,the combined spinal-epidural anesthesia group had higher MMSE score 12 and 36 hour after anesthesia,and had lower VAS score 1 day after operation(P<0.05).The incidence of complications in the spinal-epidural group was 3.13%(1/32),which was lower than the 18.75%(6/32)in the general anesthesia group(P<0.05).Conclusions Combined spinal-epidural anesthesia for elderly patients with FNF can significantly improve the effect of anesthesia block and postoperative recovery,reduce stress response and postoperative pain,and reduce the incidence of complications.