不同麻醉方式应用于老年患者髋部手术时的血流动力学变化比较  

comparison of the effect of different anesthetic techniques on the invasive hemodynamics of elderly undergone hip surgery

作　　者：曹亲亲[1] 郭献阳[2] 陈丽梅[3] 卢园园[1] 徐旭仲[3] 

机构地区：[1]温州医学院附属第二医院麻醉科,浙江温州325000 [2]温州医学院附属第二医院ICU,浙江温州325000 [3]温州医学院附属第一医院麻醉科,浙江温州325000

出　　处：《温州医学院学报》2011年第1期33-36,共4页Journal of Wenzhou Medical College

基　　金：浙江省科技计划基金资助项目(2005C33015)

摘　　要：目的:观察腰丛阻滞联合浅全麻应用于老年患者髋部手术的血流动力学变化,并与全麻、腰麻复合硬膜外麻醉比较。方法:择期行单侧髋部手术(股骨头置换或全髋关节置换)的老年患者30例,年龄≥65岁。ASAⅡ～Ⅲ级。随机分为三组:腰丛复合浅全麻组(A组)、全麻组(B组)、腰麻联合硬膜外麻醉组(C组),每组10例。测定并记录麻醉前后各时点的有创血流动力学指标。结果:三种麻醉方式对中心静脉压(CVP)、肺血管阻力指数(PVRI)、心率(HR)的影响存在差异。C组的CVP低于B组及A组。B组的PVRI显著高于A组。C组的HR高于B组。各组内各时间点间血流动力学变化存在差异。结论:老年患者髋部手术采用腰丛复合浅全麻时血流动力学变化较稳定。Objective： To compare three anesthetic techniques on the invasive hemodynamics in the elderly undergone hip surgery.Methods： Thirty patients undergoing elective lateral hip surgery（femoral head replacement or total hip replacement） were prospectively randomized 3 standardized anesthetic techniques.All patients exceeded 60 yr old with an ASA physical status of I-II.Three standardized anesthetic methods included posterior approach lumbar plexus block with sedation,combined spinal and epidural anesthesia at the L3-4 interspace and general anesthesia（each group n =10）.Invasive hemodynamics（CO,CVP,PCWP,PA,HR,MAP,PVRI,SVRI）before and in-stantly after anesthesia,during operation,terminal of anesthesia were observed.Results： There was diference during anesthesia and operation in every groups.CVP、PVRI、HR differed significantly among groups.Hemodynamics changes showed most stability in the lumbar plexus block group compared with general anesthesia group and combined spinal and epidural anesthesia group（P 0.05）.There was no significant difference among groups with respect to the other hemodynamics indexes.Conclusion： Lumbar plexus block is superior to general anesthesia or CSEA,and the invasive hemodynamics is more stability for the elderly undergone hip surgery.

关 键 词：腰丛 椎管内麻醉 全麻 老年 髋部手术 血流动力学 

分 类 号：R614.4[医药卫生—麻醉学]