不同麻醉方式对老年髋部骨折患者术中生命体征和术后恢复的影响  

Effects of different anesthesia methods on intraoperative vital signs and post-operative recovery in elderly patients undergoing hip fracture surgery

作　　者：王君婷 刘山业 袁维秀[1,2] WANG Jun-Ting;LIU Shan-Ye;YUAN Wei-Xiu(Center of Anesthesia and Operation,First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Anesthesiology,Hainan Hospital of Chinese PLA General Hospital,Sanya 572013,Hainan Province,China)

机构地区：[1]解放军总医院第一医学中心麻醉手术中心,北京100853 [2]解放军总医院海南医院麻醉科,海南三亚572013

出　　处：《中华老年多器官疾病杂志》2020年第12期904-909,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的比较全身麻醉、周围神经阻滞联合喉罩全麻和周围神经阻滞联合基础麻醉3种不同麻醉方式对老年髋部骨折患者术中生命体征和术后恢复的影响。方法选取在解放军总医院海南医院骨科择期行髋部骨折手术的老年患者60例,根据麻醉方式不同,分为3组:全身麻醉组(G组)、周围神经阻滞联合喉罩全麻组(NL组)和周围神经阻滞联合基础麻醉组(NS组)。记录基本生命体征及麻醉药物用量,应用Ramsay评分评定苏醒即刻、苏醒后5 min和出手术室时的镇静水平。疼痛视觉模拟评分(VAS)评定苏醒即刻、苏醒后5 min、出手术室和术后24 h的镇痛水平。应用简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评定患者术前1天和术后第5天的认知功能,并记录术后进食时间(h)及下床活动时间(d)。结果G组患者术中舒芬太尼用量显著高于NL组(P<0.001),NL组显著多于NS组(P<0.001)。麻醉完成后10 min,G组(P=0.003)和NL组(P=0.007)的平均动脉压(MAP)显著低于NS组,而苏醒即刻和苏醒后5 min,G组的MAP显著高于NL组和NS组(P=0.005;P=0.016)。苏醒即刻,G组的心率(HR)显著高于NS组(P=0.015)。麻醉完成后5 min、10 min、手术开始、手术结束和出手术室5个时间点,G组和NL组的脑电双频指数(BIS)显著低于NS组(P<0.05)。苏醒即刻,G组的Ramsay评分显著高于NS组(P<0.05),而VAS评分显著高于NS组(P<0.05)。术前1天和术后第5天,3组间MMSE和MoCA评分均没有显著差异(均P>0.05)。G组术后进食时间(h)显著长于NS组(P=0.048)和NL组(P=0.012)。结论针对老年患者髋部手术,神经阻滞联合基础麻醉可以获得更好的镇痛效果,同时对患者意识影响轻微,明显提早了患者术后进食时间,促进了患者术后早期的临床恢复。Objective To compare the effects of 3 different anesthesia methods(general anesthesia,peripheral nerve block combined with laryngeal mask general anesthesia,and peripheral nerve block combined with basal anesthesia)on intraoperative vital signs and postoperative recovery in elderly patients with hip fracture.Methods A total of 60 elderly patients undergoing elective hip fracture surgery admitted in Hainan Hospital of Chinese PLA General Hospital were subjected,and divided into 3 groups according to different anesthesia methods:general anesthesia group(G group),peripheral nerve block combined with laryngeal mask general anesthesia group(NL group)and peripheral nerve block combined with basal anesthesia group(NS group).Vital signs and dosages of anesthetic agents were observed and recorded during the surgery.Ramsay grade was used to evaluate the sedation levels at the time of awakening,5 min after awakening and out of operating room.Visual analogue scale(VAS)was applied to evaluate analgesia levels at the above time points and 24 h postoperatively.Mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)were employed to evaluate cognitive function in 1 d before and 5 d after the surgery.Postoperative feeding time(h)and time of getting out of bed(d)were also recorded.Results There were no significant differences in general data of patients among the 3 groups.The consumption of sufentanilin G group was significantly higher than that in NL group(P<0.001),and that in NL group was obviously higher than that in NS group(P<0.001).After 10 min of anesthesia,MAP in G group(P=0.003)and NL group(P=0.007)was significantly lower than that in NS group,while MAP in G group was significantly higher than that in NL group and NS group(P=0.005;P=0.016)immediately after resuscitation and 5 min after resuscitation.Immediately after resuscitation,HR in G group was significantly higher than that in NS group(P=0.015).BIS in G group and NL group was significantly lower than that in NS group(P<0.05)at 5 min and 10 min after

关 键 词：老年人 髋部骨折 联合麻醉 围手术期康复 

分 类 号：R614[医药卫生—麻醉学] R592[医药卫生—外科学]