腰硬联合麻醉和腰丛-坐骨神经阻滞在高龄患者股骨头置换术中的效果对比  

Comparison of effects by combined spinal and epidural analgesia and lumbar plexus-sciatic nerve block in femoral head replacement for senile patients

作　　者：谢国强[1] 欧银强 何永肖 吴彩源 

机构地区：[1]广东省四会市人民医院麻醉科,526200

出　　处：《中国实用医药》2017年第22期26-28,共3页China Practical Medicine

摘　　要：目的评价比较高龄患者股骨头置换术中应用腰硬联合麻醉(CSEA)和腰丛-坐骨神经阻滞(LSNB)的效果。方法 72例高龄股骨头置换术患者,随机分为两组,采用腰麻-硬膜外联合麻醉的36例患者作为CSEA组,而采用腰丛-坐骨神经阻滞进行麻醉的36例患者作为LSNB组,比较两组用药前(T0)和用药后10 min(T1)、30 min(T2)的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)和血氧饱和度(SpO_2)以及麻醉起效时间、麻醉效果。结果 CSEA组患者T1时的MAP、HR、RR、SpO_2水平与T0时比较差异均具有统计学意义(P<0.05);且两组患者T1时的MAP、HR、RR、SpO_2水平比较差异均具有统计学意义(P<0.05)。CSEA组患者T2时HR水平高于T0时,且高于LSBN组T2时HR水平,差异具有统计学意义(P<0.05)。CSEA组患者的起效时间(1.25±0.38)min显著短于LSBN组的(5.13±1.62)min,差异具有统计学意义(P<0.05)。CSEA组患者的麻醉效果显著高于LSBN组,差异具有统计学意义(P<0.05)。结论在高龄患者股骨头置换术中应用腰硬联合麻醉的麻醉效果更高,可以显著缩短麻醉起效时间,而腰丛-坐骨神经阻滞呼吸循环指标较为稳定,还需根据患者基础情况选择最适麻醉方式。Objective To evaluate effects by combined spinal and epidural analgesia（CSEA） and lumbar plexus-sciatic nerve block（LSNB） in femoral head replacement for senile patients.Methods A total of 72 senile patients in femoral head replacement were randomly divided into two groups,as CSEA group with 36 cases receiving combined spinal and epidural analgesia and LSNB group with 36 cases receiving lumbar plexussciatic nerve block.Comparison was made on mean arterial pressure（MAP）,heart rate（HR）,respiratory rate（RR）,oxyhemoglobin saturation（SpO2） before medication（T0） and in 10 min（T1）,30 min（T2） after medication,and anesthesia onset time and anesthetic effect between the two groups.Results The difference of MAP,HR,RR and SpO2 levels in CSEA group had statistical significance between T1 and T0（P〈0.05）,and the differences of MAP,HR,RR and SpO2 levels between the two groups at T1 all had statistical significance（P〈0.05）.CSEA group had higher HR at T2 than T0 and HR at T2 in LSBN group,and the difference had statistical significance（P〈0.05）.CSEA group had obviously shorter onset time as（1.25±0.38） min than（5.13±1.62） min in LSNB group,and the difference had statistical significance（P〈0.05）.CSEA group had obviously higher anesthetic effect than LSNB group,and the difference had statistical significance（P〈0.05）.Conclusion Implement of combined spinal and epidural analgesia shows higher anesthetic effect in femoral head replacement for senile patients,and it can remarkably shorten anesthesia onset time,however lumbar plexus-sciatic nerve block can maintain stable respiratory circulatory indexes.Therefore,appropriate anesthesia measure ought to be selected in accordance with basic condition of patients.

关 键 词：股骨头置换术 高龄 腰硬联合麻醉 腰丛-坐骨神经阻滞 

分 类 号：R614[医药卫生—麻醉学]