三种麻醉方式在高龄患者人工股骨头置换术中的效果分析  

Analysis of the efficacy of three anesthesia methods in artificial femoral head replacement for the elderly

作　　者：余云兰 黄莉莉 林加福[2] 张天浩[3] 林涧[3] Yu Yunlan;Huang Lili;Lin Jiafu;Zhang Tianhao;Lin Jian(Department of Anesthesiology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Chongming Branch,Shanghai 202150,China;Department of Basic Medicine,Fujian Health Vocational and Technical College,Fuzhou 350101,China;Department of Orthopedics,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Chongming Branch,Shanghai 202150,China)

机构地区：[1]上海交通大学医学院附属新华医院(崇明)麻醉科,上海202150 [2]福建卫生职业技术学院医学基础部,福州350101 [3]上海交通大学医学院附属新华医院(崇明)骨科,上海202150

出　　处：《创伤外科杂志》2021年第6期465-467,471,共4页Journal of Traumatic Surgery

基　　金：上海市卫生和计划生育委员会科研课题(201840198);上海市老龄化健康专项研究基金项目(2020YJZX0143)。

摘　　要：目的探讨三种不同麻醉方式在急性股骨颈闭合性骨折高龄患者人工股骨头置换术中的疗效分析。方法前瞻性分析2014年2月—2020年10月上海交通大学医学院附属新华医院(崇明)麻醉科收治120例急性股骨颈闭合性骨折高龄患者行人工股骨头置换手术,男性55例,女性65例;年龄70~90岁,平均75.5岁;均为单侧股骨颈骨折;患者受伤致手术时间2~4d。根据随机数字表法分为全身麻醉插管组(插管组)、全身麻醉喉罩组(喉罩组)、连续硬膜外神经阻滞组(神经阻滞组),每组40例,三组患者均在一个手术治疗组。记录并进行比较手术中三组患者的麻醉效果(麻醉操作时间、术中出血量、术中输液量、术中输血量、手术时间、术后睁眼时间、术后定向力恢复时间、术后麻醉随访情况)。结果术前操作时间神经阻滞组高于插管组(27.8±1.5)min vs.(17.1±1.5)min及喉罩组(22.3±1.6)min,插管组又高于喉罩组;术中出血量、术中输液量、术中输血量和手术时间三组差异无统计学意义(P>0.05);神经阻滞组术后睁眼时间(手术操作过程中会给予镇静药物让患者入睡)插管组(17.5±3.2)min,喉罩组(17.6±3.3)min,神经阻滞组(11.2±3.2)min和术后定向力恢复时间插管组(17.7±2.9)min,喉罩组(17.9±3.1)min,神经阻滞组(11.9±2.7)min均较插管组及喉罩组显著缩短(P<0.05);神经阻滞组麻醉恢复期骚动发生率显著低于插管组及喉罩组,但同时术后随访时,患者不适主诉发生率神经阻滞组明显高于插管组及喉罩组(P<0.05)。结论三种麻醉方法在高龄人工股骨头置换术中各有优缺点,喉罩麻醉具有操作简单,麻醉效果满意,术后不适主诉少的优点,更值得在临床上推广。Objective To investigate the effect of different anesthesia methods in artificial femoral head replacement for those suffered with acute closed femoral neck fracture.Methods A retrospective analysis of 120 patients treated with artificial femoral head replacement from Feb.2014 to Oct.2020 was carried out.There were 55 males and 65 females aged 70-90 years,with an average of 75.5 years.All were unilateral femoral neck fractures.The injury to operation time was 2-4 days.They were divided into three groups according to anesthesia method:intubation group(group A),laryngeal mask group(group B)and epidural anesthesia group(group C),each group with 40 patients.All patients in the 3 groups were treated by the same surgical treatment group.Anesthesia operation time,intraoperative blood loss,infusion volume,blood transfusion volume,operation time,eye opening time,recovery time of orientation and postoperative anesthesia follow-up were observed and recorded.Results Anesthesia operation time(minutes)of group C was more than that of group A and group B(P<0.05)(group A:17.1±1.5,group B:22.3±1.6,group C:27.8±1.5,minutes);Intraoperative blood loss,infusion volume,blood transfusion volume and operation time among the three groups had no significant difference(P>0.05);Eye opening time after operation(group A:17.5±3.2,group B:17.6±3.3,group C:11.2±3.2,minutes)and recovery time(group A:17.7±2.9,group B:17.9±3.1,group C:11.9±2.7,minutes)of orientation force of group C were significantly less than those of group A and B(P<0.05).The incidence of disturbances during extubation in group C was significantly lower than that of group A and B,during the postoperative follow-up,however,the incidence of complaint of discomfort in group C was higher than that of group A and B.Conclusion Each of the three anesthesia methods has its advantages and disadvantages in senile artificial femoral head replacement.In comparison,laryngeal mask anesthesia has the advantages of simple operation,satisfactory anesthesia effect and less postoperative

关 键 词：创伤麻醉 股骨颈骨折 置换术 高龄 

分 类 号：R614[医药卫生—麻醉学]