丙泊酚-瑞芬太尼静脉麻醉复合局部浸润麻醉用于老年髋部骨折效果评价  

Propofol-Remifentanil Intravenous Anesthesia Combined with Local Infiltration Anesthesia in Elderly Patients with Hip Fracture

作　　者：赵华宇[1] 刘彦辉[1] 刘平水[1] 康书峰[2] ZHAO Huayu;LIU Yanhui;LIU Pingshui;KANG Shufeng(Friendship Hospital of the Third Hospital of Hebei Medical University,Shijiazhuang,Hebei,China 050051;Xiangjiang Hospital of the Third Hospital of Hebei Medical University,Shijiazhuang,Hebei,China 050035)

机构地区：[1]河北医科大学第三医院友谊院区,河北石家庄050051 [2]河北医科大学第三医院湘江院区,河北石家庄050035

出　　处：《中国药业》2020年第10期145-148,共4页China Pharmaceuticals

基　　金：河北省医学科学研究重点课题[20150730]。

摘　　要：目的探讨丙泊酚-瑞芬太尼静脉麻醉复合局部浸润麻醉用于老年髋部骨折的效果。方法选取医院2014年1月至2017年12月收治的老年髋部骨折患者90例,随机分为丙泊酚组(A组)、腰硬联合麻醉组(B组)和全麻组(C组),各30例。3组患者均予髋部骨折术,术前B组患者予蛛网膜下腔、硬膜外联合麻醉,C组患者予喉罩全身麻醉,A组患者予丙泊酚-瑞芬太尼静脉麻醉复合局部浸润麻醉。结果 A组患者的麻醉操作时间、苏醒时间明显短于B组和C组,单位时间麻醉用药量、液体输注量均明显低于B组和C组,且组间比较差异有统计学意义(P <0. 05);术后A组患者的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)均明显高于B组和C组,且组间比较差异有统计学意义(P<0. 05);术后24h时,A组患者简易智力状态检查量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分均明显高于B组和C组,且组间比较差异有统计学意义(P <0. 05);A组、B组、C组不良反应发生率分别为6. 67%,23. 33%,33. 33%,组间比较差异有统计学意义(P <0. 05)。结论丙泊酚-瑞芬太尼静脉麻醉复合局部浸润麻醉用于老年髋部骨折麻醉效果较好,能改善患者术后的认知功能。Objective To investigate the effect of propofol-remifentanil intravenous anesthesia combined with local infiltration anesthesia in elderly patients with hip fracture. Methods Ninety elderly patients with hip fracture who were treated in the hospital from January2014 to December 2017 were selected and randomly divided into the propofol group( group A),lumbar-epidural anesthesia group( group B) and general anesthesia group( group C),30 cases in each group. All groups were treated with hip fracture surgery. Before surgery,group B was given combined subarachnoid and epidural anesthesia,group C was given laryngeal mask anesthesia,and group A was given propofol-remifentanil intravenous anesthesia combined with local infiltration anesthesia. Results The anesthesia operation time,recovery time,anesthetic dosage per unit time and liquid infusion volume of group A were significantly lower than those of group B and group C( P < 0. 05). The postoperatively heart rate( HR),mean arterial pressure( MAP) and blood oxygen saturation( SpO2) of group A were significantly higher than those of group B and group C( P < 0. 05). At 24 h after operation,the scores of Mini-mental State Examination( MMSE) and Montreal Cognitive Assessment( MoCA) in group A were significantly higher than those in group B and group C( P < 0. 05). The incidence of adverse reactions in groups A,B,and C were 6. 67%,23. 33% and 33. 33%,respectively,with significant difference between groups( P < 0. 05). Conclusion Propofol-remifentanil intravenous anesthesia combined with local infiltration anesthesia has good anesthetic effect on elderly patients with hip fracture,can improve the cognitive function of patients after operation.

关 键 词：老年 髋部骨折 静脉麻醉 丙泊酚 瑞芬太尼 浸润麻醉 认知功能 

分 类 号：R969.4[医药卫生—药理学] R971.2[医药卫生—药学]