不同比重腰麻及硬膜外复合麻醉对下肢内固定修复术麻醉效果及血流动力学的影响  

Influence of different proportion of spinal-epidural anesthesia on anesthesia effect and hemodynamics in patients with lower extremity internal fixation repair

作　　者：谭毅[1] 熊威威[1] 梁萌[1] 陈治军[1] 

机构地区：[1]桂林医学院附属医院麻醉科,广西桂林541000

出　　处：《海南医学》2018年第5期646-649,共4页Hainan Medical Journal

基　　金：广西自然科学基金(编号:2015JJAA40020)

摘　　要：目的探讨不同比重腰麻及硬膜外复合麻醉对下肢内固定修复术麻醉效果及血流动力学的影响。方法选取2015年1~12月在桂林医学院附属医院择期接受单侧下肢手术的70例患者为研究对象,根据麻醉方式的不同将其分成观察组和对照组,各35例。观察组采取低密度小剂量腰麻及硬膜外复合麻醉,对照组采取持续硬膜外麻醉。观察比较两组患者血流动力学变化和下肢改良Bromage评分情况,以及麻醉阻滞见效时间(T1)、患者痛觉恢复时间(T2)和麻醉药用量。结果观察组下肢改良Bromage评分情况、麻醉药用量[(5.8±0.7)mg vs(35.8±1.3)mg]、麻醉阻滞见效时间(T1)[(5.2±1.5)s vs(9.9±2.7)s]以及患者痛觉恢复时间(T2)[(6.6±1.8)s vs(17.1±4.4)s]均明显优于对照组,差异有统计学意义(P<0.05);两组患者平均动脉压和心率相比较,除麻醉后5 min时差异有统计学意义(P<0.05)外,其他各时间点两组比较差异无统计学意义(P>0.05)。观察组各时间点的平均动脉压和心率情况与麻醉前相比差异均无统计学意义(P>0.05);对照组麻醉后5 min和10 min时间点的平均动脉压[(71.4±13.7)mm Hg、(73.7±17.9)mm Hg]和心率[(80.3±12.1)次/min、(81.2±11.2)次/min]情况与麻醉前[(84.4±22.5)mm Hg、(78.0±15.8)次/min]比较差异均具有统计学意义(P<0.05)。两组患者术后均无认知功能障碍发生,生命体征均保持平稳。结论行下肢内固定修复术患者采用小剂量、低密度腰麻及硬膜外复合麻醉,具有麻药用量少、阻滞起效快、阻滞完全和镇痛效果理想等优点,且患者血流动力学稳定性较好。Objective To explore the influence of different proportion of spinal-epidural anesthesia on anesthe-sia effect and hemodynamics in patients with lower extremity internal fixation repair. Methods Seventy patients under-going unilateral lower extremity internal fixation repair from January 2015 to December 2015 in our hospital were select-ed and divided into observation group and control group by anesthesia manner. Each group included 35 cases. The obser-vation group received low-density and small-dose spinal-epidural anesthesia, and the control group received continuousepidural anesthesia. Hemodynamic changes, lower extremity modified Bromage score, effectual-time of anesthesia （T1）,recovery time of pain （T2）, dose of narcotic were observed and compared between the two groups. Results The lowerextremity modified Bromage score, dose of narcotic （5.8±0.7） mg vs （35.8±1.3） mg, T1 （5.2±1.5） s vs （9.9±2.7） s, T2（6.6±1.8） s vs （17.1±4.4） s in the observation group were significantly better than those in the control group （P〈0.05）.The mean arterial pressure and heart rate showed no statistically significant differences between the two groups at dif-ferent time points （P〉0.05）, excepting at 5 min after anesthesia （P〈0.05）. The mean arterial pressure and heart rate atall the time points after anesthesia in the observation group showed no significant differences with those before anes-thesia （P〉0.05）. The mean arterial pressure, heart rate at 5 min and 10 min after anesthesia in the control group were（71.4±13.7） mmHg and （73.7±17.9） mmHg, （80.3±12.1） beats/min and （81.2±11.2） beats/min, as compared with （84.4±22.5） mmHg, （78±15.8） beats/min before anesthesia （P〈0.05）. There was no cognitive dysfunction occurred and vitalsigns remained stable in the two groups. Conclusion The small-dose, low-density spinal-epidural anesthesia in lowerextremity internal fixation repair has the advantages of low dose, quick blockage, complete bloc

关 键 词：腰麻 麻醉阻滞 下肢内固定修复 血流动力学 

分 类 号：R614[医药卫生—麻醉学]