高龄患者髋部骨折手术前优化措施下不同麻醉方式的效果比较

Comparison of effects between different anesthesia methods under preoperative optimal measures in elderly patients with hip fracture

目的比较术前优化措施下不同麻醉方式在高龄患者髋部骨折手术中的应用效果。方法选取2022年5月至2023年12月该院行髋部骨折手术的120例高龄(≥75岁)患者为研究对象,分为A组和B组,每组60例。两组术前均采用优化措施,A组行“二单三低”(单侧、单次、低位、低浓度、低剂量)腰麻,B组行喉罩人工气道全麻。比较两组手术开始切皮(T_(1))、手术开始30 min(T_(2))、手术结束缝皮(T_(3))、手术结束(T_(4))、手术结束后30 min(T_(5))时的血流动力学变化,术后苏醒时间,以及烦躁、恶心呕吐、术后谵妄(POD)等并发症发生率。结果T_(1)时,B组收缩压、心率低于A组,差异有统计学意义(P<0.05);T_(4)时,B组收缩压、心率高于A组,差异有统计学意义(P<0.05)。两组术后不同苏醒时间比例,烦躁、恶心呕吐、POD等并发症发生率比较差异有统计学意义(P<0.05)。结论在术前优化措施基础上,选择“二单三低”腰麻方式在高龄患者髋部骨折手术时血流动力学更平稳,并发症更少,术后恢复更快。

Objective To compare the application effects of different anesthesia methods under preoperative optimization measures in elderly patients with hip fracture surgery.Methods A total of 120 elderly patients(≥75 years old)with hip fracture surgery in this hospital from May 2022 to December 2023 were selected as the study subjects and divided into group A and group B,60 cases in each group.The two groups adopted the preoperative optimization measures.The group A performed“two single three low”(unilateral,once,low position,low concentration and low dose)lumbar anesthesia,while group B conducted the laryngeal mask artificial airway anesthesia.The hemodynamic changes at skin incision in operation beginning(T_(1)),at 30 min after operation(T_(2)),suture at operation end(T_(3)),at the end of operation(T_(4))and at 30 min after operation end(T_(5)),postoperative recovery time and occurrence situation of complications such as nausea and vomiting,agitation,postoperative delirium(POD)were compared between the two groups.Results The systolic blood pressure and the heart rate at T_(1)in group B were lower than those in group A,and the differences were statistically significant(P<0.05).The systolic blood pressure and heart rate at T_(4)in group B were higher than those in group A,and the difference was statistically significant(P<0.05).The recovery time,agitation,nausea and vomiting and incidence rate of adverse reactions such as POD had no statistical difference between the two groups(P<0.05).Conclusion On the basis of preoperative optimization measures,selecting the“two single three low”lumbar anesthesia method in elderly patients with hip fracture surgery anesthesia has more stable hemodynamics,less complications and faster postoperative recovery.