腰硬联合麻醉在髋部骨折患者中的应用价值分析

Analysis of application value of combined spinal-epidural anesthesia in patients with hip fractures

目的分析腰硬联合麻醉在髋部骨折患者中的应用效果。方法50例髋部骨折患者,随机分成对照组和观察组,每组25例。对照组采用重比重腰硬联合麻醉,观察组采用等比重腰硬联合麻醉。比较两组麻醉指标(麻醉起效时间、运动阻滞恢复时间、感觉阻滞恢复时间、术后清醒时间、麻醉药物用量),不良事件(低氧血症、血压升高、血压降低)发生情况,麻醉效果,麻醉前后血压、心率,术后血清炎性因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]水平。结果观察组麻醉起效时间、运动阻滞恢复时间、感觉阻滞恢复时间、术后清醒时间均短于对照组,麻醉药物用量少于对照组(P<0.05)。麻醉后,观察组患者舒张压为(73.43±8.02)mm Hg(1 mm Hg=0.133 kPa)、收缩压为(108.67±5.26)mm Hg、心率为(85.34±5.48)次/min,高于对照组的(65.05±4.15)mm Hg、(90.35±7.69)mm Hg、(80.24±8.03)次/min(P<0.05)。观察组不良事件发生率为8.00%,低于对照组的32.00%(P<0.05)。术后,观察组IL-6水平为(104.52±30.13)ng/L、TNF-α水平为(1.74±0.24)ng/ml、CRP水平为(22.27±2.41)mg/L,均低于对照组的(132.46±30.02)ng/L、(2.51±0.25)ng/ml、(27.65±2.04)mg/L(P<0.05)。观察组麻醉优良率为96.00%,高于对照组的68.00%(P<0.05)。结论等比重腰硬联合麻醉在髋部骨折患者中使用可以提升麻醉效果,有效减少不良事件,值得推广应用。

Objective To analyze the application effect of combined spinal-epidural anesthesia in patients with hip fractures.Methods 50 patients with hip fracture were randomly divided into a control group and an observation group,with 25 patients in each group.The control group received isobaric combined spinal-epidural anesthesia,while the observation group received hyperbaric combined spinal-epidural anesthesia.Both groups were compared in terms of anesthesia indexes(onset time of anesthesia,recovery time of motor block,recovery time of sensory block,postoperative waking time,dosage of anesthetic drugs),occurrence of adverse events(hypoxemia,elevated blood pressure,decreased blood pressure),anesthetic effect,blood pressure and heart rate before and after anesthesia,postoperative serum inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)].Results The onset time of anesthesia,recovery time of motor block,recovery time of sensory block and postoperative waking time of the observation group were shorter than those of the control group,and the dosage of anesthesia drugs was lower than that of the control group(P<0.05).After anesthesia,the diastolic blood pressure of the observation group was(73.43±8.02)mm Hg(1 mm Hg=0.133 kPa),the systolic blood pressure was(108.67±5.26)mm Hg and the heart rate was(85.34±5.48)beats/min,which were higher than(65.05±4.15)mm Hg,(90.35±7.69)mm Hg,(80.24±8.03)beats/min in the control group(P<0.05).The incidence of adverse events in the observation group was 8.00%,which was lower than 32.00% in the control group(P<0.05).After operation,the observation group had IL-6 of(104.52±30.13)ng/L,TNF-α of(1.74±0.24)ng/ml,CRP of(22.27±2.41)mg/L,which were lower than(132.46±30.02)ng/L,(2.51±0.25)ng/ml and(27.65±2.04)mg/L in the control group(P<0.05).The excellent and good rate of anesthesia in the observation group was 96.00%,which was higher than 68.00% in the control group(P<0.05).Conclusion The use of isobaric combined spinal-epidural anesthesia in patients with hip fracture can improve the effect of anesthesia and effectively reduce complications,and it is worthy of promotion.