硬膜外麻醉与腰硬联合麻醉对下肢骨折患者呼吸功能及血流动力学的影响

Effects of epidural anesthesia and combined spinal epidural anesthesia on respiratory function and hemodynamics in patients with lower extremity fracture

目的:探讨硬膜外麻醉与腰硬联合麻醉对下肢骨折患者呼吸功能及血流动力学的影响。方法:选取2022年3月至2023年3月鹤壁煤业(集团)有限责任公司总医院收治的84例下肢骨折患者,以简单随机数字表法分成研究组、对照组,各42例。对照组采取硬膜外麻醉,研究组采取腰硬联合麻醉,对比两组麻醉前后呼吸功能、血流动力学水平及麻醉效果。结果:麻醉前,两组SBP、DBP、HR、RR、SPO 2水平比较无差异(P>0.05);麻醉中,两组SBP、DBP、RR、SPO 2水平均较麻醉前降低,对照组低于研究组,而两组HR水平均较麻醉前升高,对照组高于研究组(P<0.05);手术结束后,两组SBP、DBP、SPO 2水平高于麻醉中,但低于麻醉前,对照组低于研究组,而两组HR、RR水平低于麻醉中,HR水平高于麻醉前,对照组高于研究组,而RR水平低于麻醉前,对照组低于研究组(P<0.05)。研究组麻醉起效时间、麻醉阻滞完全时间、苏醒时间等均短于对照组(P<0.05)。研究组麻醉总有效率优于对照组(P<0.05)。结论:腰硬联合麻醉弥补了硬膜外麻醉的不足之处,在获得手术需求的麻醉效果的同时,又降低了对下肢骨折患者呼吸功能、血流动力学水平的影响。

Objective:To explore the effect of epidural anesthesia and combined spinal and epidural anesthesia on respiratory function and hemodynamics in patients with lower extremity fracture.Methods:A total of 84 patients with lower extremity fracture treated from March 2022 to March 2023 were randomly divided into study group and control group by simple random number table method,with 42 patients in each group.The control group received epidural anesthesia,and the study group received lumbo-epidural anesthesia.The respiratory function,hemodynamic level,anesthesia status and effect of the two groups were compared before and after anesthesia.Results:Before anesthesia,there were no differences in SBP,DBP,HR,RR and SPO 2 levels between the two groups(P>0.05).During anesthesia,the levels of SBP,DBP,RR and SPO 2 in both groups were lower than before anesthesia,and the control group was lower than the study group,while the HR levels in both groups were higher than before anesthesia,and the control group was higher than the study group(P<0.05).After surgery,the levels of SBP,DBP and SPO 2 in the two groups were higher than those in anesthesia,but lower than before anesthesia,and the control group was lower than the study group;the levels of HR and RR in the two groups were lower than those in anesthesia,and the HR level was higher than that before anesthesia,and the control group was higher than that in the study group;the RR level was lower than that before anesthesia,and the control group was lower than that in the study group(P<0.05).The onset time of anesthesia,the complete time of anesthesia block and the recovery time of the study group were shorter than those of the control group(P<0.05).The total effective rate of anesthesia in the study group was better than that in the control group(P<0.05).Conclusion:Combined epidural anesthesia makes up for the shortcomings of epidural anesthesia.It not only achieves the anesthetic effect required for surgery,but also reduces the impact on the respiratory function and hemodynamic level of patients with lower extremity fracture.