腰硬联合麻醉在老年骨折患者中的应用

Application of Combined Spinal-epidural Anesthesia in Elderly Patients with Fracture

目的 对比研究老年骨折患者手术治疗中采取全麻与腰硬联合麻醉的作用与影响。方法 方便选择2020年12月—2021年12月仪征市中医院收诊的骨折老年患者154例,根据手术时间先后顺序分为对照组(2020年12月—2021年5月,77例)和观察组(2021年6—12月,77例),对照组手术患者采取全麻方案,观察组手术患者实施腰硬联合麻醉方案,比较两组患者麻醉质量,监测两组患者麻醉不同时间的心率及血压,统计两组患者的不良反应发生率。结果 观察组患者起效时间及完全阻滞时间均短于对照组,药物用量少于对照组,差异有统计学意义(P<0.05)。麻醉前,两组患者心率及血压比较,差异无统计学意义(P>0.05),麻醉15、30 min及术后15 min,观察组患者血压、心率均高于对照组,差异有统计学意义(P<0.05)。观察组患者麻醉过程中不良反应总发生率(2.60%)和术后不良反应总发生率(5.19%)均低于对照组,差异有统计学意义(χ^(2)=6.805、7.265,P<0.05)。结论 老年骨折患者手术治疗中应首选腰硬联合麻醉方案,能够减轻对患者心率、血压波动地影响,减少患者术中与术后不良反应,安全性更佳,倡导运用推广。

Objective To compare the effect and influence of general anesthesia and combined spinal-epidural anesthesia for elderly fracture patients. Methods Conveniently selected 154 elderly patients with fractures admitted in Yizheng Hospital of Traditional Chinese Medicine from December 2020 to December 2021, which were divided into control group(from December 2020 to May 2021, 77 cases) and observation group(from June to December 2021, 77cases) according to the sequence of operation, the control group underwent general anesthesia, while the observation group underwent combined anesthesia, compared the anesthesia quality of the two groups, monitored the heart rate and blood pressure of the two groups at different times of anesthesia, and counted the incidence of adverse reactions of the two groups. Results The onset time and complete block time of the observation group were shorter than control group, the drug amount was less than that of the control group, the difference was statistically significant(P<0.05). Before anesthesia, compared the heart rate and blood pressure between the two groups, the difference was not statistically significant(P>0.05). For 15 min and 30 min of anesthesia and 15 min after surgery, the blood pressure and heart rate in the observation group were higher than the control group, the difference was statistically significant(P<0.05). The during anesthesia incidence of adverse reactions(2.60%) and postoperative adverse reactions(5.19%) in the observation group were lower than those in the control group, and the difference was significant(χ^(2)=6.805, 7.265,P<0.05). Conclusion The combined spinal-epidural anesthesia scheme should be the first choice for the surgical treatment of elderly fracture patients, which can reduce the impact on the patient’s heart rate and blood pressure fluctuations, weaken the patient’s intraoperative and postoperative adverse reactions, and has better safety.