老年股骨颈骨折手术患者腰硬联合麻醉和全身麻醉的效果比较

发布时间：2018-05-14 02:15

本文选题：腰硬联合麻醉 + 全身麻醉　；参考：《中国老年学杂志》2015年15期

【摘要】：目的比较腰硬联合麻醉和全身麻醉用于老年患者股骨颈骨折手术麻醉中的临床效果。方法对择期接受手术治疗的老年股骨颈骨折患者分别进行全身麻醉和腰硬联合麻醉,比较两种麻醉方法的临床效果及对患者术后短期认知功能的影响。结果腰硬联合麻醉组患者在术后1、2、5 h血压、心率变化幅度较小,而全身麻醉组患者在术后1、2、5 h变化明显(均P0.05)。腰硬联合麻醉组患者的起效时间、术后意识恢复时间、术后完全清醒时间较全身麻醉组明显缩短(均P0.05)。在麻醉后24 h,全身麻醉组的简易精神状况检查法(MMS)评分明显低于硬膜联合麻醉组(t=6.11,P0.05),其余时间两组的MMS评分比较无明显差异(P0.05)。腰硬联合麻醉组术后6 h视觉模拟评分法(VAS)评分、恶心呕吐、头晕嗜睡和肺部感染均明显低于全身麻醉组(均P0.05)。结论对于老年股骨颈骨折手术患者,全身麻醉和腰硬联合麻醉均能提供良好的麻醉和术后镇痛,而腰硬联合麻术后镇痛效果更好,而且在短期内对老年患者认知功能的影响较小,不良反应少,更适合临床推广。
[Abstract]:Objective to compare the clinical effects of combined spinal-epidural anesthesia and general anesthesia in elderly patients with femoral neck fracture. Methods General anesthesia and combined spinal-epidural anesthesia were performed on the elderly patients with femoral neck fracture. The clinical effects of the two anesthesia methods and their effects on the short-term cognitive function after operation were compared. Results the blood pressure and heart rate of the patients in the combined spinal-epidural anesthesia group were less than those in the general anesthesia group at 1: 2 and 5 hours postoperatively (P < 0.05). The onset time, postoperative consciousness recovery time and postoperative total waking time of patients in the combined spinal-epidural anesthesia group were significantly shorter than those in the general anesthesia group (all P 0.05). At 24 hours after anesthesia, the score of simple psychiatric examination in general anesthesia group was significantly lower than that in combined epidural anesthesia group (6.11p 0.05). There was no significant difference in MMS score between the two groups at the other time (P 0.05). Visual analogue score, nausea and vomiting, dizziness and pulmonary infection were significantly lower in the combined spinal-epidural anesthesia group than in the general anesthesia group (all P 0.05). Conclusion for elderly patients with femoral neck fracture, general anesthesia and combined spinal-epidural anesthesia can provide good anesthesia and postoperative analgesia, but combined spinal-epidural anesthesia is more effective. In the short term, the effect on cognitive function of elderly patients is small and the adverse reaction is less, so it is more suitable for clinical application.
【作者单位】：宁波市北仑区人民医院;
【分类号】：R614

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