老年髋关节置换过程中硬膜外麻醉与腰-硬联合麻醉:血液动力学差异

发布时间：2018-06-14 21:43

本文选题：关节成形术 + 置换　；参考：《中国组织工程研究》2015年13期

【摘要】：背景:腰-硬联合麻醉和硬膜外麻醉均是老年人手术中常用的麻醉方式,各有优缺点。采用合适的麻醉方式保持循环稳定可以降低患者的手术风险和并发症,提高治疗成功率。目的:分析对比硬膜外麻醉与腰-硬联合麻醉在老年髋关节置换中的麻醉效果以及对于血流动力学的影响。方法:选择髋关节置换老年患者80例,随机分为两组,每组40例,试验组予以腰-硬联合麻醉,对照组予以硬膜外麻醉。对比两组患者各时间点的平均动脉压、心率和中心静脉压变化,感觉、运动阻滞起效及恢复时间,麻醉后30 min各阻滞平面和Bromage运动阻滞评分以及麻醉效果。结果与结论:对照组麻醉后5 min、30 min和术毕的平均动脉压显著低于麻醉前和试验组同时间点(P0.05);对照组麻醉后5 min、30 min和术毕的心率显著高于麻醉前和试验组同时间点(P0.05);对照组麻醉后5 min、30 min和术毕的中心静脉压显著高于麻醉前和试验组同时间点(P0.05)。试验组的感觉、运动阻滞起效时间显著短于对照组,感觉、运动阻滞恢复时间显著长于对照组(P0.01)。两组患者麻醉后30 min各阻滞平面和Bromage运动阻滞评分差异无显著性意义(P0.05)。试验组的麻醉效果显著优于对照组(χ2=5.691 7,P=0.017 00.05)。提示与硬膜外麻醉相比,腰-硬联合麻醉可以减少髋关节置换患者的血流动力学变化,麻醉效果更佳。
[Abstract]:Background: combined spinal-epidural anesthesia and epidural anesthesia are common anesthetic methods in the elderly, each has its own advantages and disadvantages. Proper anesthesia to maintain stable circulation can reduce the surgical risk and complications, and improve the success rate of treatment. Aim: to compare the effects of epidural anesthesia and combined spinal-epidural anesthesia on hip replacement and hemodynamics in elderly patients. Methods: 80 elderly hip replacement patients were randomly divided into two groups, 40 cases in each group. The experimental group was given combined spinal-epidural anesthesia and the control group was given epidural anesthesia. The changes of mean arterial pressure, heart rate and central venous pressure, sensation, time of onset and recovery of motor block, scores of block level and Bromage block at 30 min after anesthesia and anaesthesia effect were compared between the two groups. Results and conclusion: the mean arterial pressure at 30 min after anesthesia and at the end of operation in the control group was significantly lower than that in the control group at the same time point before anesthesia and at the same time point (P0.05), and the heart rate in the control group was significantly higher than that in the control group at 5 minutes after anesthesia and the heart rate at the end of operation at the same time point before anesthesia and in the test group. The central venous pressure at 30 min after anesthesia in the control group was significantly higher than that in the control group and at the same time point before anesthesia and at the same time point in the experimental group. In the experimental group, the onset time of motor block was significantly shorter than that of the control group, and the recovery time of motor block was significantly longer than that of the control group (P 0.01). There was no significant difference in block level and Bromage motor block score 30 min after anesthesia between the two groups (P 0.05). The anaesthesia effect of the trial group was significantly better than that of the control group (蠂 ~ 2 = 5.6917). Compared with epidural anesthesia, combined spinal-epidural anesthesia can reduce hemodynamic changes in hip replacement patients, and the anesthetic effect is better.
【作者单位】：中山市黄圃人民医院麻醉科;
【分类号】：R614

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