布比卡因椎管内麻醉与芬太尼联合丙泊酚全身麻醉对老年骨科手术患者的疗效对比研究  

A Efficacy Comparative Study of Bupivacaine Intraspinal Anesthesia and Fentanyl combined with Propofol General Anesthesia in Elderly Patients Undergoing Orthopaedic Surgery

作　　者：詹普怡 刘铭[1] 廖希 ZHAN Puyi;LIU Ming;LIAO Xi(910 Hospital of the Joint Logistics Support Force of the ChinesePeople's Liberation Army, Fujian Fuzhou 362000, China)

机构地区：[1]中国人民解放军联勤保障部队第910医院麻醉科

出　　处：《河北医学》2019年第6期972-976,共5页Hebei Medicine

基　　金：2015年福建省自然科学基金项目,(编号:2015J01597)

摘　　要：目的:布比卡因椎管内麻醉与芬太尼联合丙泊酚全身麻醉对老年骨科手术患者的疗效对比研究。方法:主要是对2017年1月至2017年12月在我院进行老年骨科手术的患者进行研究,共包括了60例,其中对照组(芬太尼联合丙泊酚全身麻醉)和观察组(布比卡因椎管内麻醉)的患者均为30例。比较对两组患者的睁眼以及手术和语言陈述时间等进行记录,同时记录患者的麻醉药用量。对患者在手术前以及手术后的各个阶段来进行认知功能测评。结果:与对照组相比,观察组患者在手术以及患者睁眼时间上明显较短,同时麻药的计量以及语言陈述时间同样低于对照组(P<0.05)。与对照组相比,观察组在术后的三个时间段内(术后1h、术后3h、术后6h)的MMSE评分明显较高(P<0.05)。与对照组相比,观察组在术后的三个时间段内(术后1h、术后3h、术后6h)的P3潜伏期明显较短(P<0.05);与对照组相比,观察组在术后的三个时间段内(术后1h、术后3h、术后6h)的P3波幅明显较高(P<0.05)。结论:在对老年骨科手术中进行麻醉时,椎管内麻醉有着更好的效果,其不仅能够有效的缩短睁眼以及手术和语言陈述时间,同时也能使得麻药用量有效减少,进而对于患者的认知能力和精神状态的影响较小,患者能够更早康复。Objective: To efficacy compare bupivacaine intraspinal anesthesia with fentanyl combined with propofol general anesthesia in elderly patients undergoing orthopaedic surgery. Methods: A total of 60 elderly patients undergoing orthopaedic surgery in our hospital from January 2017 to December 2017 were studied, including 30 patients in the control group (fentanyl combined with propofol general anesthesia) and 30 patients in the observation group (bupivacaine intraspinal anesthesia). The physiological indexes of the two groups were compared. Results: Compared with the control group, the observation group had significantly shorter operation time and eye opening time, and the anesthetic dosage and language presentation time were also lower than the control group (P<0.05). Compared with the control group, the MMSE score of the observation group was significantly higher in the three time periods (1 hour, 3 hours and 6 hours after operation)(P<0.05). Compared with the control group, the incubation period of P 3 in the observation group was significantly shorter (P<0.05) in the three postoperative periods (1h, 3h and 6h), and the amplitude of P 3 in the observation group was significantly higher (P<0.05) in the three postoperative periods (1h, 3h and 6h). Conclusion: Intraspinal anesthesia has a better effect in the elderly orthopedic surgery. It can not only shorten the time of opening eyes, operation and language presentation, but also reduce the dosage of anesthetics effectively. It has less influence on the cognitive ability and mental state of the patients, and the patients can recover earlier.

关 键 词：老龄化 骨科手术 全身麻醉 椎管内麻醉 认知功能 事件相关电位 

分 类 号：R614[医药卫生—麻醉学]