单侧腰麻复合硬膜外麻醉对老年下肢骨折患者围手术期血流动力学及循环功能的影响  

Effect of unilateral lumbar anesthesia combined with epidural anesthesia on perioperative hemodynamics and circulatory function in elderly patients with lower extremity f racture

作　　者：李高桥 LI Gaoqiao(Department of Anesthesiology,Mudan Central Hospital of Heze City,Heze 274000,Shandong,China)

机构地区：[1]菏泽市牡丹区中心医院麻醉科,山东菏泽274000

出　　处：《当代医药论丛》2023年第6期33-35,共3页

摘　　要：目的:分析单侧腰麻(蛛网膜下腔阻滞麻醉)复合硬膜外麻醉对老年下肢骨折患者围手术期血流动力学及循环功能的影响。方法:将70例择期行单侧下肢骨折手术的老年患者按随机双盲法分为两组,其中35例术中行硬膜外麻醉的患者为对照组,另35例术中行单侧腰麻复合硬膜外麻醉的患者为观察组。对比两组围手术期的血流动力学指标、循环功能及麻醉情况。结果:麻醉后5 min(T_(1))、60 min(T_(2))时,两组的心率(HR)均加快,平均动脉压(MAP)均降低(P<0.05),术毕(T_(3))时均逐渐恢复,其中观察组T_(1)、T_(2)时的HR均低于对照组,MAP均高于对照组(P<0.05)。T_(1)、T_(2)时,两组的心输出量(CO)、肺毛细血管楔压(PCWP)、肺动脉压(PAP)均降低(P<0.05),T_(3)时均逐渐恢复,其中观察组T_(1)、T_(2)时的CO、PCWP、PAP均高于对照组(P<0.05)。观察组的麻醉起效时间、感觉阻滞时间、痛觉恢复时间均短于对照组,麻醉药用量少于对照组(P<0.05)。结论:单侧腰麻复合硬膜外麻醉可维持老年下肢骨折患者围手术期血流动力学的稳定,减轻对循环功能的影响。Objective:To analyze the effects of unilateral lumbar anesthesia(subarachnoid block anesthesia)combined with epidural anesthesia on perioperative hemodynamics and circulatory function in elderly patients with lower limb fracture.Methods:70 elderly patients undergoing unilateral lower limb fracture surgery were randomly divided into two groups according to the double blind method,among which 35 patients undergoing intraoperative epidural anes thesia were the control group,and 35 patients undergoing intraoperative unilateral lumbar anesthesia combined with epidural anesthesia were the observation group.The perioperative hemodynamic indexes,circulation function and anesthesia were compared between the two groups.Results:At 5 min(T_(1))and 60 min(T_(2))after anesthesia,the heart rate(HR)of the two groups increased,the mean arterial pressure(MAP)decreased(P<0.05),and gradually recovered after the operation(T_(3)).The HR at T_(1) and T_(2) of the observation group was lower than that of the control group,and the MAP was higher than that of the control group(P<0.05).The cardiac output(CO),pulmonary capillary wedge pressure(PCWP)and pulmonary artery pressure(PAP)of both groups were decreased at T_(1) and T_(2)(P<0.05),and gradually recovered at T_(3).The CO,PCWP and PAP of the observation group were higher than those of the control group at T_(1) and T_(2)(P<0.05).The onset time of anesthesia,sensory block time and pain recovery time in the observation group were shorter than those in the control group,and the dosage of anesthesia was less than that in the control group(P<0.05).Conclusion:Unilateral lumbar anesthesia combined with epidural anesthesia can maintain the stability of perioperative hemodynamics in elderly patients with lower limb fracture and reduce the influence on circulation.

关 键 词：单侧腰麻 硬膜外麻醉 老年下肢骨折 血流动力学 循环功能 

分 类 号：R614[医药卫生—麻醉学]