低剂量丙泊酚静脉麻醉复合局部浸润麻醉在老年髋关节骨折患者手术麻醉中的应用  

Application of low-dose propofol intravenous anesthesia combined with local infiltration anesthesia in surgical anesthesia of elderly patients with hip fractures

作　　者：赵华宇[1] 霍树平[1] 刘彦辉[1] Zhao Huayu;Huo Shuping;Liu Yanhui(Department of Anesthesiology,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,Hebei,China.)

机构地区：[1]河北医科大学第三医院麻醉科,河北石家庄050051

出　　处：《贵州医药》2020年第8期1185-1188,共4页Guizhou Medical Journal

基　　金：河北省卫生厅科研基金项目(编号:20150730)。

摘　　要：目的分析低剂量丙泊酚静脉麻醉复合局部浸润麻醉在老年髋关节骨折患者手术麻醉中的应用。方法选择髋关节骨折患者90例,随机分为A、B、C三组,每组30例。A组行腰硬联合麻醉、B组行全身麻醉、C组行低剂量丙泊酚静脉麻醉复合局部浸润麻醉。对比三组一般手术情况、麻醉效果、呼吸循环功能、麻醉苏醒情况、麻醉舒适度、麻醉相关并发症及预后情况。结果三组中4例行全髋关节置换术(THR)、41例行人工股骨头置换术(BFHR)、40例行闭合复位、5例行开放复位手术,手术类型、手术时间、术中失血量、术中补液量及麻醉效果比较差异均无统计学意义(P>0.05);B组不同时间节点的SpO2、MAP、HR、CVP水平比较差异有统计学意义(P<0.05);B组麻醉T2、T3、T4时SpO2、MAP显著低于A、C组,HR、CVP水平显著高于A、C组(P<0.05);三组苏醒时BIS、术后疼痛情况比较差异无统计学意义(P>0.05),但睁眼时间、拔管时间、麻醉恢复室(PACU)停留时间、麻醉药物总剂量差异均有统计学意义(P<0.05),且A、C组显著低于B组(P<0.05);术毕三组麻醉舒适度评分差异有统计学意义(P<0.05),且B、C组舒适度均显著高于A组,B组麻醉相关并发症总发生率高于A、C组(P<0.05);三组手术相关并发症总发生率无统计学意义(P>0.05);三组首次下床活动时间、术后住院时间比较差异有统计学意义(P<0.05),且C组显著低于A、B组(P<0.05)。结论低剂量丙泊酚静脉麻醉复合局部浸润麻醉用于老年髋关节骨折患者手术麻醉,不仅麻醉效果与腰硬联合麻醉、气管插管全麻相当,且对呼吸循环功能影响小,低剂量麻醉药物于降低麻醉及手术相关并发症风险均有重要价值,更利于术后恢复。Objective To analyze the application of low-dose propofol intravenous anesthesia combined with local infiltration anesthesia in surgical anesthesia of elderly patients with hip fractures.Methods 90 cases of patients with hip fractures who were treated in our hospital were selected for the study and were divided into group A,group B and group C according to the zoning random method,with 30 in each group.Group A was given combined spinal and epidural anesthesia,and group B was given general anesthesia,and group C was given low-dose propofol intravenous anesthesia combined with local infiltration anesthesia.The general surgery,anesthesia effects,respiratory and circulatory function,anesthesia recovery,anesthesia comfort,anesthesia-related complications and prognosis were compared among the three groups.Results Among the three groups,there were 4 cases in total hip replacement(THR),41 cases in artificial femoral head replacement(BFHR),40 cases in closed reduction and 5 cases in open reduction,and there were no statistical significantly differences in the surgery types,operative time,intraoperative blood loss,intraoperative fluid volume and anesthetic effects(P>0.05).There were statistical significantly differences in the SPO2,MAP,HR and CVP level in group B at different time points(P<0.05).And SPO2 and MAP in group B were significantly lower than those in group A and group C at T2,T3 and T4,and the HR and CVP were significantly higher than those in group A and group C(P<0.05).There were no statistical significantly differences in BIS at recovery and postoperative pain among the three groups(P>0.05).However,there were statistical significantly differences in the blink time,extubation time,PACU stay and total anesthetic dose(P<0.05),and in group A and group C were significantly lower than those in group B(P<0.05).The difference in anesthesia comfort score among the three groups was statistically significant(P<0.05),and the comfort in group B and group C was significantly higher than that in group A,and the total incide

关 键 词：低剂量丙泊酚 静脉麻醉复合局部浸润麻醉 老年髋关节骨折 麻醉 

分 类 号：R614[医药卫生—麻醉学]