摘要
目的:探讨高龄病人股骨头置换术中实施腰丛-坐骨神经阻滞及腰硬联合麻醉的麻醉效果差异。方法:选取78例病人为研究对象,按麻醉方式的不同将其分为2组,实施腰硬联合麻醉的39例为腰硬组,实施腰丛-坐骨神经阻滞麻醉的39例为神经阻滞组。观察2组麻醉阻滞前后的血流动力学变化、疼痛视觉模拟量表(VAS)评分,术中血管活性药物及镇痛药物的使用情况。结果:麻醉前,2组病人血压和心率比较差异均无统计学意义(P>0.05),经不同阻滞后,2组病人心率及舒张压差异均无统计学意义(P>0.05),但收缩压神经阻滞组显著高于腰硬组(P<0.01)。且麻醉后2组血压均较麻醉前下降(P<0.05~P<0.01),腰硬组心率较麻醉前下降(P<0.05),神经阻滞组麻醉前后心率差异无统计学意义(P>0.05)。经麻醉后,腰硬组VAS评分明显低于神经阻滞组(P<0.01);2组VAS评分均显著低于麻醉前(P<0.01)。腰硬组术中麻黄碱用量、补液量均显著多于神经阻滞组(P<0.01),腰硬组术中镇痛药物用量少于神经阻滞组(P<0.05)。结论:腰丛-坐骨神经阻滞及腰硬联合麻醉均可用于高龄病人股骨头置换术,2种麻醉方式对病人血流动力学均无明显影响,其中腰硬联合麻醉术中镇痛药物用量少,镇痛效果显著,在实际临床麻醉中应充分考虑病人实际情况选择合适的麻醉方式。
Objective:To investigate the differences of anesthesia effects between lumbar plexus-sciatic nerve block and combined spinal-epidural anesthesia in elderly patients treated with femoral head replacement.Methods:A total of 78 patients treated with femoral head replacement were divided into two groups according to different anesthesia methods.Thirty-nine patients treated with combined lumbar-epidural anesthesia and 39 cases treated with lumbar plexus-sciatic nerve block were divided into the spinal-epidural group and nerve block group,respectively.The hemodynamic changes and VAS score before and after anesthesia,intraoperative vasoactive drugs and analgesic drugs were observed in two groups.Results:There was no statistical significance in blood pressure and heart rate between two groups before anesthesia(P>0.05).After anesthesia,the difference of the heart rate and diastolic blood pressure between two groups were not statistically significant(P>0.05),and the level of systolic pressure in nerve block group was higher than that in spinal-epidural group(P<0.01).After anesthesia,the blood pressure levels in two groups decreased compared with before anesthesia(P<0.05 to P<0.01),the heart rate in spinal-epidural group decreased compared with before anesthesia(P<0.05),and the difference of the heart rate in nerve block group was not statistically significant between before and after anesthesia(P>0.05).After anesthesia,the VAS score in spinal-epidural group was significantly lower than that in nerve block group(P<0.01),and the VAS scores in two groups were significantly lower than those before anesthesia(P<0.01)The amount of intraoperative ephedrine and fluid supplementation in spinal-epidural group were significantly higher than those in nerve block group(P<0.01),and the amount of intraoperative analgesic drugs in spinal-epidural group was lower than that in nerve block group(P<0.05).Conclusions:Lumbar plexus-sciatic nerve block and combined spinal-epidural anesthesia can be used in elderly patients treated with femoral h
作者
唐巨
TANG Ju(Department of Anesthesiology,Xuanhan People′s Hospital,Xuanhan Sichuan 636150,China)
出处
《蚌埠医学院学报》
CAS
2020年第1期64-66,70,共4页
Journal of Bengbu Medical College
关键词
股骨头置换术
高龄
腰丛-坐骨神经阻滞
腰硬联合麻醉
femoral head replacement
elderly
lumbar plexus-sciatic nerve block
combined spinal-epidural anesthesia
