摘要
目的比较右美托咪定辅助硬膜外麻醉和丙泊酚-瑞芬太尼全身麻醉用于高龄美国麻醉医师协会（ASA）分级Ⅲ级患者全髋骨置换术的临床效果。方法收集荆门市第一人民医院2012年2月至2013年7月收治的57例高龄（≥90岁）ASAⅢ级全髋骨置换术患者的临床麻醉资料,其中右美托咪定辅助硬膜外麻醉27例（A组）,丙泊酚-瑞芬太尼全身麻醉30例（B组）。比较两组患者围术期呼吸循环的稳定情况和术后麻醉恢复情况,术后24 h随访麻醉并发症发生情况及麻醉满意度情况。结果 1A组患者手术期间生命体征无明显波动（P〉0.05）。B组患者麻醉诱导前后及气管插管后血压和心率均出现显著波动（P〈0.05）。B组患者围术期心血管药物使用比例显著高于A组患者（P〈0.01）。2A组患者18例术后直接回病房,9例在麻醉恢复室观察0.5-1 h;B组13例术后控制呼吸直接回重症医学科病房,9例拔除气管导管,回重症医学科病房;8例在麻醉恢复室观察1-2 h。3B组患者术后认知功能障碍发生情况显著高于A组（P〈0.05）,同时麻醉满意度低于A组（P〈0.01）。结论适度剂量的右美托咪定辅助硬膜外麻醉是高龄ASAⅢ级患者全髋骨置换术时一种有效和安全的麻醉方案。
Objective To compare the clinical effects between dexmedetomidine-assisted epidural anesthesia and propofol-remifentanil general anesthesia in total hip replacement surgery for aged patients of American Society of Anesthesiologists（ ASA） Ⅲgrade. Methods The clinical anesthesia data of 57 aged patients（ ≥90 years） of ASA Ⅲ grade underwent total hip replacement surgeries in Jingmen First People＇s Hospital from Feb. 2012 to Jul. 2013 were collected. Patients received dexmedetomidine-assisted epidural anesthesia included 27 cases（ group A） and patients received propofol-remifentanil general anesthesia included 30 cases（ group B）,the perioperative stability of respiration and circulation,postoperative anesthetic recovery,as well as the incidences of anesthesia complications 24 h after the surgery and anesthesia satisfaction of the two groups were compared. Results 1There were no obvious fluctuation of vital signs during the operation in group A（ P〉0. 05）. There had were fluctuations of blood pressure and heart rate before and after anesthesia induction and tracheal intubation in group B（ P〈0. 05）. Proportion of perioperative cardiovascular drug application in Group B was significantly higher than that in group A（ P〈0. 01）. 2 In group A,18 cases directly returned to the ward after surgery,9 cases stayed in anesthesia recovery room for observation of 0. 5-1 h; in group B,13 cases with postoperative controlled breathing directly returned to the intensive care unit,9 cases returned to the intensive care unit after extubation,8 cases stayed in anesthesia recovery room for observation of 1-2 h. 3The incidence of postoperative cognitive dysfunction in group B was significantly higher than that in group A（ P〈0. 05）,while the degree of anesthesia satisfaction was extremely lower than that in group A（ P〈0. 01）. Conclusion For aged patients of ASA Ⅲ grade,moderate doses of dexmedetomidine-assisted epidural anesthesia is an effective and safe anesthesia in total hip replacem
出处
《医学综述》
2015年第12期2252-2254,共3页
Medical Recapitulate
关键词
全髋骨置换术
硬膜外麻醉
全身麻醉
右美托咪定
老年
Total hip replacement
Epidural anesthesia
General anesthesia
Dexmedetomidine
Elderly
