3种麻醉方式在老年髋部骨折手术治疗中的应用效果  

The effects of three anesthesia methods in the surgical treatment of elderly hip fracture

作　　者：赖尚导[1] 陈伟元[1] 谌业光[2] 黄健[3] 刘炯峰 陈燕中 LAI Shang-dao;CHEN Wei-yuan;CHEN Ye-guang;HUANG Jian;LIU Jiong-feng;CHEN Yan-zhong(Dept of Anesthesia,the People′s Hospital of Meizhou City,Meizhou,Guangdong 514031,China)

机构地区：[1]梅州市人民医院麻醉科,广东梅州514031 [2]梅州市人民医院创伤骨外科,广东梅州514031 [3]梅州市人民医院关节外科,广东梅州514031

出　　处：《临床骨科杂志》2019年第6期708-711,共4页Journal of Clinical Orthopaedics

摘　　要：目的比较3种麻醉方式在老年髋部骨折手术治疗中的应用效果。方法将60例老年髋部骨折手术患者随机分为3组,每组20例:N-B组采取腰丛+坐骨神经阻滞麻醉,G-A组采取气管插管全身麻醉,G-N组采取气管插管全身麻醉联合腰丛+坐骨神经阻滞麻醉。比较:①3组手术时间、术中出血量;②3组血流动力学指标;③3组术后不良反应发生例数;④G-A组和G-N组的全身麻醉用药总量、拔管时间及拔管后躁动率;⑤3组不同时段的VAS评分。结果①3组手术时间、术中出血量比较差异无统计学意义(P>0.05)。②T4时,N-B组动脉压、心率均高于G-A组和G-N组(P<0.05),G-A组动脉压、心率均高于G-N组(P<0.05);T5时,N-B组动脉压、心率仍均高于G-A组和G-N组(P<0.05)。③G-N组、N-B组术后不良反应总发生例数均低于G-A组(P<0.05)。④全身麻醉用药总量和拔管时间G-N组均低于G-A组(P<0.05)。⑤G-N组术后12、24 h VAS评分均低于N-B组和G-A组(P<0.05)。结论老年髋部骨折患者手术采用气管插管全身麻醉联合腰丛+坐骨神经阻滞麻醉,术中血流动力学稳定,术后不良反应发生率低,可提供比较确切的术后镇痛,麻醉效果安全可靠。Objective To compare the effects of three anesthesia methods in the surgical treatment of hip fracture in the elderly.Methods Sixty elderly patients who underwent hip fracture surgery were randomly divided into three groups,20 cases in each group.N-B group received lumbar plexus plus sciatic nerve block anesthesia,G-A group received tracheal intubation general anesthesia,G-N group received tracheal intubation general anesthesia combined with lumbar plexus plus sciatic nerve block anesthesia.The next data were compared,including①the operation time and intraoperative bleeding volume of the three groups;②the hemodynamic indexes of the three groups;③the number of adverse reactions after operation in the three groups;④the total volume of general anesthesia drugs,extubation time and agitation rates after extubation in G-A group and G-N group;⑤the VAS of the three groups in different periods.Results①There were no significant differences in operation time and intraoperative bleeding among the three groups(P>0.05).②At T4,the arterial pressures and heart rates in N-B group were higher than those in G-A group and G-N group(P<0.05),while which were higher in G-A group than those in G-N group(P<0.05);at T5,the arterial pressures and heart rates in N-B group were still higher than those in G-A group and G-N group(P<0.05).③The total number of cases with postoperative adverse reactions in G-N group and N-B group were lower than those in G-A group(P<0.05).④The total volume of general anesthesia drugs and extubation time in G-N group were lower than those in G-A group(P<0.05).⑤VAS of G-N group were lower than those of N-B group and G-A group at 12,24 h after operation(P<0.05).Conclusions General anesthesia with tracheal intubation combined with lumbar plexus and sciatic nerve block anesthesia is used in elderly patients with hip fracture.The intraoperative hemodynamics is stable and the incidence of adverse reactions is low.It can provide accurate postoperative analgesia and the anesthetic effect is safe and re

关 键 词：麻醉方式 老年人 髋骨折/外科学 

分 类 号：R683.3[医药卫生—骨科学] R687.3[医药卫生—外科学]