不同麻醉方法对老年膝关节置换患者血流动力学和不良反应的影响  

Effects of Different Anesthetic Methods on Hemodynamics and Adverse Reactions in Elderly Patients Undergoing Knee Arthroplasty

作　　者：伍国芳[1] 罗玉金[1] 夏丽花[1] 彭冬华[1] WU Guo-fang;LUO Yu-jin;XIA Li-hua;PENG Dong-hua(Department of Anesthesiology,Central Hospital of Loudi,Loudi,Hunan 417000,China)

机构地区：[1]娄底市中心医院麻醉科,湖南娄底417000

出　　处：《河北北方学院学报（自然科学版）》2018年第12期5-8,共4页Journal of Hebei North University:Natural Science Edition

基　　金：湖南省娄底市科技创新项目(娄新财企指2015-252)

摘　　要：目的观察不同麻醉方法对老年膝关节置换患者血流动力学和不良反应的影响。方法 90例单侧膝关节置换患者随机分为3组:神经阻滞组(A组),腰硬联合组(B组),全麻组(C组),每组30例。记录并比较3组患者不同时点T1(麻醉开始前)、T2(麻醉后5min)、T3(手术开始)、T4(手术开始后30min)、T5 (手术结束)的平均动脉血压(mean arterial pressure,MAP)、心率(heart rate,HR);记录术后尿潴留、低氧血症(SpO2<90%)、恶心、呕吐、嗜睡及术后6h内疼痛等不良反应的发生情况。结果 T2时A组MAP明显高于B组、C组,A组HR明显高于C组,差异均有统计学意义(P<0.05);A组术后不良反应发生率明显低于B组、C组,差异均有统计学意义(P<0.05)。结论神经阻滞用于老年膝关节手术具有血流动力学平稳、不良反应少、术后镇痛作用时间长等优点,可用于老年单侧膝关节置换术。Objective To observe effects of different anesthetic methods on hemodynamics and adverse reactions in elderly patients undergoing knee arthroplasty.Methods 90 patients undergoing knee arthroplasty were equally randomized into three groups:nerve block group(group A),combined spinal-epidural anesthesia(group B),and general anesthesia group(group C).Mean arterial pressure(MAP)and heart rate(HR)were measured at T1(before the beginning of anesthesia),T2(5minutes after anesthesia),T3(at the beginning of the operation),T4(30minutes after operation),and T5(at the end of the operation).Adverse reactions such as urinary retention,hypoxemia,nausea,vomiting,lethargy and pain within 6hours after operation were recorded.Results MAP of group A at T2 was significantly higher than those of group B and group C,HR of group A was significantly higher than that of group C,and the difference was statistically significant(P <0.05).Incidence of postoperative adverse reactions in group A was significantly lower than those in group B and C,and the difference was statistically significant(P<0.05).Conclusion Nerve block has the advantages of stable hemdynamics,less adverse reactions and long time of postoperative analgesia.It can be used in unilateral knee arthroplasty in the elderly.

关 键 词：老年 膝关节置换 麻醉方法 血流动力学 不良反应 

分 类 号：R687.4[医药卫生—骨科学]