不同麻醉方式在老年下肢手术中麻醉效果及对术后转归的影响  

Effect of Different Anesthesia Methods on Elderly Lower Limb Surgery and Its Effect on Postoperative Outcome

作　　者：李莲娣[1] 苗慧[1] 岳文江[1] 赵艳晶[1] 郭玲[1] 于广浩 LI Liandi;MIAO Hui;YUE Wenjiang;ZHAO Yanjing;GUO Ling;YU Guanghao(Department of Anesthesiology,The Second Affiliated Hospital of Mudanjiang Medical University,Mudanjiang Heilongjiang 157011,China;Department of Imaging Equipment,School of Medical Imaging,Mudanjiang Medical University,Mudanjiang Heilongjiang 157011,China)

机构地区：[1]牡丹江医学院第二附属医院麻醉科,黑龙江牡丹江157011 [2]牡丹江医学院医学影像学院影像设备教研室,黑龙江牡丹江157011

出　　处：《中国卫生标准管理》2020年第15期125-127,共3页China Health Standard Management

基　　金：黑龙江省卫生计生委科研课题(2017-324);黑龙江省省属高等学校基本科研业务费科研项目(2018-KYYWFMY-0049);牡丹江市科学技术计划项目(Z2018s064);黑龙江省教育科学规划课题(GJC1318110)。

摘　　要：目的探讨不同麻醉方式对接受下肢手术的老年患者的麻醉效果和安全性以及对术中血流动力学变化和术后转归的影响。方法2018年1月—2019年9月,单侧下肢手术的老年患者216例。随机分成组1、组2和组3,各组分别采用神经阻滞麻醉、腰硬联合麻醉和全身麻醉。比较围术期血流动力学变化、术后ICU入住率、治疗满意度及并发症。结果麻醉完成时,组1MAP为(103.84±10.31) mmHg,高于组2(83.11±7.92)mmHg(t=13.508,P=0.000)和组3(82.54±7.82)mm Hg (t=14.132,P=0.000);三组ICU入住率分别为24.00%(18/75),34.29%(24/70),62.00%(45/73),三组间差异有统计学意义(χ2=23.218,P=0.000)。组间两两比较表示,组3分别与组1、组2间的差异具有统计学意义(χ1,32=11.309,P=0.001)、(χ2,32=10.711,P=0.001);三组治疗满意度比较具有统计学意义(F=20.627,P=0.000),组间(t1,2=2.685,P=0.008)、(t1,3=6.552,P=0.000)、(t2,3=2.958,P=0.004)均具有统计学意义(P<0.05);并发症三组间差异有统计学意义(P<0.05)。组1的并发症发生率低于组3(χ21,3=11.254,P=0.001)。结论腰丛和坐骨神经阻滞对伴有重要器官合并症的老年患者行下肢手术是安全有效的,不仅术中血流动力学平稳,还可降低术后ICU入住率和住院时间。Objective To explore the effect and safety and the influence to the hemodynamic changes and postoperative outcome of different anesthesia methods in gerontal patient in lower extremity surgery.Methods From January 2018 to September 2019,216 elderly patients wth one-sided lower extremity surgery were selected.Divided into group 1;group 2;group 3.Each group was treated with nerve block anesthesia,combined spinal and epidural anesthesia,and general anesthesia.Compared the perioperative hemodynamic changes,ICU occupancy rate,satisfaction and complications.Results When the anesthesia was completed,the MAP of group 1 was(103.84±10.31)mmHg,which was higher than group 2(83.11±7.92)mmHg(t=13.508,P=0.000)and group 3(82.54±7.82)mmHg(t=14.132,P=0.000);ICU occupancy rates of the three groups were 24.00%(18/75),34.29%(24/70),62.00%(45/73),and the difference between the three groups was statistically significant(χ2=23.218,P=0.000).Pairwise comparison between groups indicated that the differences between group 3 and group 1 and group 2 were statistically significant(χ1,32=11.309,P=0.001),(χ2,32=10.711,P=0.001);3 groups of treatment Satisfaction was statistically significant(F=20.627,P=0.000),among groups(t 1,2=2.685,P=0.008),(t 1,3=6.552,P=0.000),(t 2,3=2.958,P=0.004)were statistically significant(P<0.05);the difference between the three groups of complications was statistically significant(P<0.05).The complication rate of group 1 was lower than group 3(χ21,3=11.254,P=0.001).Conclusion Lumbar plexus-sciatic nerve block is effective and safe for gerontal patient accompanied with major organ dysfunction undergoing unilateral lower extremity surgery.It exerts slight influence on hemodynamic stability and reduces ICU occupancy rate and shortens median length of hospital stay.

关 键 词：腰丛-坐骨神经阻滞 腰硬联合麻醉 全身麻醉 MAP 满意度 并发症 

分 类 号：R614[医药卫生—麻醉学]