神经阻滞和全身麻醉对老年股骨转子间骨折患者的影响  

Effects of nerve block anesthesia versus general anesthesia on intertroehanterie fractures in the elderly

作　　者：赵树山[1] 李朝晖 阮哲 林涨源[1] 龙海涛[1] 赵瑞波[1] 朱峥嵘[1] 卢邦宝[1] 孙步 华成亮 朱剑熹[1] 唐朝辉[2] 朱勇[1] Zhao Shushan;Li Zhaohui;Ruan Zhe;Lin Zhangyuan;Long Haitao;Zhao Ruibo;Zhu Zhengrong;Lu Bangbao;Sun Buhua;Cheng Liang;Zhu Jianxi;Tang Zhaohui;Zhu Yong(Department of Orthopedics,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Anesthesiology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院骨科,长沙410008 [2]中南大学湘雅医院骨科,麻醉科410008

出　　处：《中华老年医学杂志》2018年第12期1348-1351,共4页Chinese Journal of Geriatrics

摘　　要：目的 回顾性分析神经阻滞麻醉和全身麻醉方式对老年股骨转子间骨折患者的影响. 方法 收集2015年1月至2017年6月中南大学湘雅医院骨科因股骨转子间骨折住院行闭合复位髓内钉内固定术治疗的老年患者病历资料,数据采用SPSS 16. 0 或者Graph Pad Prism 6. 0软件进行统计分析. 结果 最终纳入研究104例,其中全身麻醉组48例,神经阻滞56例.两组受试对象一般情况无统计学差异.神经阻滞组术中心率、收缩压及舒张压最大变化、术中补液量分别为(12.7 ± 7.3)次/min ,(22.5 ± 8.8/12.2 ± 7.5)mmHg(1 mmHg=0.133kPa) ,(792.9 ± 387.0) ml显著低于全身麻醉组,其分别为(18.1 ± 7.8)次/min ,(34.3 ± 7.9/21.6 ± 6.6)mmHg ,(1 083 ± 445.5)ml(t=3.64 、7.14 、6.73 、5.16 ,均 P<0.05).其他围术期相关数据及术后3个月、1年死亡患者数差异无统计学意义. 结论 与全身麻醉相比,神经阻滞麻醉对老年股骨转子间骨折术中心率及血压影响较少,术中输液量较少,术后患者死亡率无明显增加,是安全可靠值得临床进一步推广的麻醉方式.Objective To retrospectively analyze the effects of nerve block anesthesia versus general anesthesia on intertrochanteric fracture in the elderly. Methods The 104 elderly inpatients undergoing closed reduction and intramedullary nailing for the treatment of femoral intertrochanteric fractures were recruited into this study at Department of Orthopedics ,Xiangya Hospital ,Central South University from January 2015 to June 2017.Medical records were collected and analyzed by SPSS 16.0 or GraphPad Prism 6.0 software. Results A total of 104 patients were divided into general anesthesia group(n= 48 )and nerve block anesthesia group (n= 56 ). There was no statistical difference in the demographic characteristics between the two groups. The changes in heart rate ,maximum changes of systolic/diastolic blood pressures ,and infusion volume during surgery were lower in the nerve block anesthesia group than in the general anesthesia group [(12.7 ± 7.3)vs. (18.1 ± 7.8)beats/min ,(22.5 ± 8.8/12.2 ± 7.5)mmHg vs. (34.3 ± 7.9/21.6 ± 6.6)mmHg ,(792.9 ± 387.0)ml vs. (1 083.0 ± 445.5)ml ,respectively ,t=3.64 ,7.14 ,6.73 ,5.16 ,all P<0.01]. There was no statistically significant difference between two groups in other perioperative data and the number of deaths at three months and one year after surgery. Conclusions As compared with the general anesthesia ,the nerve block anesthesia has less effects on the heart rate ,less maximum changes of systolic and diastolic blood pressures ,and less infusion volume during surgery ,and has no significant increase in postoperative mortality ,which is safe and worthy of further promotion.

关 键 词：神经阻滞麻醉 全身麻醉 股骨转子间骨折 血流动力学 

分 类 号：R687.3[医药卫生—骨科学]