蛛网膜下腔阻滞麻醉在老年髋关节置换术患者中的应用效果

Application effects of subarachnoid block anesthesia in elderly patients undergoing hip replacement

目的:观察蛛网膜下腔阻滞麻醉在老年髋关节置换术患者中的应用效果。方法:选取2018年1月至2021年1月于该院行髋关节置换术的100例老年患者的临床资料进行回顾性分析,按髋关节置换术中麻醉方法不同分为研究组(n=52)和对照组(n=48)。两组均行髋关节置换术,对照组采用全身麻醉,研究组采用蛛网膜下腔阻滞麻醉。比较两组不同时间[麻醉前(T)、麻醉后10 min(T)、切皮时(T)、手术结束(T)]血流动力学指标[心率(HR)、收缩压(SBP)]水平、术后24 h视觉模拟评分法(VAS)评分、简易精神状态量表(MMSE)评分、术后谵妄发生率和麻醉不良反应发生率。结果:研究组术后24 h VAS评分为(3.67±1.20)分,明显低于对照组的(4.39±1.33)分,差异有统计学意义(P<0.05);术后1 h,两组MMSE评分均低于术前,但研究组高于对照组,差异有统计学意义(P<0.05);T—T,两组HR、SBP水平组间比较,差异无统计学意义(P>0.05);两组术后谵妄发生率、麻醉不良反应发生率比较,差异无统计学意义(P>0.05)。结论:蛛网膜下腔阻滞麻醉应用于老年髋关节置换术患者可降低术后24 h VAS评分,提高术后1 h MMSE评分,效果优于全身麻醉。

Objective:To observe application effects of subarachnoid block anesthesia in elderly patients undergoing hip replacement.Methods:The clinical data of 100 elderly patients who underwent hip replacement in this hospital from January 2018 to January 2021 were retrospectively analyzed.According to different anesthesia methods,they were divided into study group (n=52) and control group (n=48).Both groups underwent hip replacement.The control group was treated with general anesthesia,while the study group used subarachnoid block anesthesia.The levels of hemodynamic indexes[heart rate (HR),systolic blood pressure (SBP)]at different time[before anesthesia (T),10 min after anesthesia (T),skin incision (T),end of the surgery (T)],the visual analogue scale (VAS) score 24 h after the surgery,the mini-mental state examination (MMSE)score,the incidence of postoperative delirium,and the incidence of adverse reactions of anesthesia were compared between the two groups.Results:The VAS score of the study group 24 h after the surgery was (3.67±1.20) points,which was signi?cantly lower than the control group of (4.39±1.33)points,and the difference was statistically signi?cant (P<0.05).1 h after the surgery,the MMSE scores of the two groups were lower than those before the surgery,but that of the study group was higher than that of the control group,and the differences were statistically signi?cant (P<0.05).There were no signi?cant differences in the HR and SBP levels between the two groups at T—T(P>0.05).There were no signi?cant differences in the incidence of postoperative delirium and adverse reactions of anesthesia between the two groups (P>0.05).Conclusions:The subarachnoid block anesthesia for the elderly patients undergoing hip replacement can reduce the VAS score 24 h after the surgery and improve the MMSE score 1 h after the surgery.Moreover,it is superior general intravenous anesthesia.