全麻与等比重腰麻对行髋关节置换术老年患者术后并发症的影响

The comparison of complications between general anesthesia and isobaric spinal anesthesia for total hip arthroplasty in elderly patients

目的比较全麻与等比重腰麻对行髋关节置换术老年患者术后并发症的影响。方法选择在两种不同麻醉方式下行单侧髋关节置换术80例,分为A组40例为等比重腰麻组(蛛网膜下腔给予布比卡因15 mg+芬太尼50μg),B组40例为全身麻醉组(全凭静脉麻醉),观察并比较2组患者术后3 d肺部并发症(肺部感染、肺水肿、肺不张等)的发生率,术后3 d心血管不良事件(心肌梗死、心绞痛、心衰等)的发生率,术后3 d认知功能障碍(POCD)的患病率。结果 80例患者中,A组术后3 d肺部并发症4例(10%),明显低于B组9例(22.5%,P<0.05);A组术后3 d发生心血管不良事件1例(2.5%),明显低于B组5例(12.5%,P<0.05);A组术后3 d患POCD 11例(27.5%),明显低于B组21例(52.5%,P<0。05)。结论与全身麻醉比较,等比重腰麻术后不良反应发生率低,更适用于老年患者全髋关节置换术。

Objective To compare the influence of general anesthesia and isobaric spinal anesthesia on postoperative complications in elderly patients with the total hip arthroplasty. Methods Eighty old patients undergoing primary and unilateral total hip arthroplasty were randomly assigned to two groups: isobaric spinal anesthesia group(group A,n = 40,subarachnoid block with 15mg of 0. 5%bupivacaine and 50ug of fentanyl),general anesthesia group(group B,n = 40). The pulmonary complications(pulmonary infection,pulmonary edema,pulmonary atelectasis),cardiovascular complications(myocardial infarction,angina,heart failure) and the changes of cognitive function(postoperative cognitive dysfunction,POCD) were recorded three days after the surgery. Results In 80 patients,there were four patients(10%) with pulmonary complications in group A three days after surgery,9 cases(22. 5%) in group B,which were significantly higher(P = 0. 038). There were one patient(2. 5%) with cardiovascular complications in group A 3 days after surgery,and five cases(12. 5%) in group B,which were significantly higher(P < 0. 05). There were 11 patients(27. 5%) with POCD in group A three days after surgery,21 cases(52. 5%) in group B,which were significantly higher(P < 0. 05). Conclusion Comparing with general anesthesia,the isobaric spinal anesthesia(15mg of 0. 5% bupivacaine and 50ug of fentanyl) may be a safer and better option with lower incidence of complications for elderly patients undergoing total hip arthroplasty.