文章摘要
王建成,杨俊华,陆咏梅,邢镝,李娜.腰硬联合麻醉对老年下肢骨折患者围术期应激反应的影响[J].中国临床保健杂志,2020,23(2):267-271.
腰硬联合麻醉对老年下肢骨折患者围术期应激反应的影响
Effect of combined spinal-epidural anesthesia on perioperative stress response in elderly patients with lower limb fracture
投稿时间:2019-09-30  
DOI:10.3969/J.issn.1672-6790.2020.02.032
中文关键词: 骨折  围手术期  麻醉,硬膜外  麻醉,脊椎  应激,生理学  老年人
英文关键词: Fractures,bone  Perioperative period  Anesthesia,epidural  Anesthesia,spinal  Stress,physiological  Aged 〖FL
基金项目:广东省东莞市社会科技发展(一般)项目(2018507150281401)
作者单位E-mail
王建成 广东东莞市第八人民医院麻醉科,523320 627501341@qq.com 
杨俊华 广东东莞市第八人民医院麻醉科,523320 962131149@qq.com 
陆咏梅 广东东莞市第八人民医院麻醉科,523320  
邢镝 广东东莞市第八人民医院麻醉科,523320  
李娜 广东东莞市第八人民医院麻醉科,523320  
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中文摘要:
      目的 旨在分析腰硬联合麻醉对老年下肢骨折患者围术期应激反应的影响。方法 选取66例老年下肢骨折患者作为研究对象,采取随机数字表法将其分为观察组和对照组,各33例。两组患者进入手术室前均不给予术前用药,观察组采取腰硬联合麻醉,对照组进行气管插管全身麻醉。选取麻醉前(T0)、麻醉完成后即刻(T1)、手术开始(T2)、手术结束(T3)、麻醉结束(T4)5个时间点作为观察对象,比较两组心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)等血流动力学指标,并比较两组麻醉效果、肌松效果、并发症等情况。结果 观察组和对照组T0时,HR、MAP 、CVP差异无统计学意义;T1时,观察组与对照组HR、MAP、CVP均有所下降,但观察组与T0相比较下降幅度较小,两组之间差异有统计学意义;观察组T2时HR、MAP、CVP无明显变化,和观察组同时间点相比,对照组T2时HR、MAP、CVP水平明显升高;至T3时手术结束及T4时患者清醒后,两组血流动力学指标均有所升高,但观察组升高幅度较小而接近麻醉前T0水平,对照组升高幅度大且明显高于T0水平,两组之间差异有统计学意义。两组术中麻醉效果、肌松效果差异无统计学意义。镇静评分、手术后疼痛视觉模拟评分法评分、下肢深静脉栓塞、认知功能障碍等并发症比较,对照组明显高于观察组,组间差异有统计学意义。结论 腰硬联合麻醉应用于老年下肢骨折手术有较好的麻醉效果,且对老年患者围术期血流动力学影响更小,降低应激反应,术后不良反应的发生率低。
英文摘要:
      Objective To analyze the effect of combined spinal-epidural anesthesia on perioperative stress response in elderly patients with lower limb fracture.Methods 66 elderly patients with lower limb fracture were selected as study subjects.They were divided into observation group and control group according to random number table method,with 33 cases in each group.Before entering the operating room,preoperative medication was not given to two groups.The observation group received combined spinal-epidural anesthesia,while the control group received general anesthesia with tracheal intubation in the operation.Before anesthesia (T0),immediately after anesthesia (T1),at the beginning of operation (T2),at the end of operation (T3) and at the end of anesthesia (T4) were selected as observation objects.The hemodynamic indexes such as heart rate (HR),mean arterial pressure (MAP) and central venous pressure (CVP) were compared between the two groups,meanwhile,the anesthetic effect,the effect of muscle relaxation and complications were compared.Results There were no significant differences in HR,MAP and CVP between the observation group and the control group at T0;HR,MAP and CVP decreased in the observation group and the control group at T1,however,the decreases of HR,MAP and CVP in the observation group were smaller than those in the control group,and the difference between the two groups was statistically significant;HR,MAP and CVP in the observation group did not change significantly at T2.The levels of HR,MAP and CVP in the control group increased significantly at T2 compared with those in the observation group at the same time,while the hemodynamic indexes in the two groups increased slightly at T3 and T4,but the increase in the observation group was small and close to the level of T0 before anesthesia,while that in the control group was large and significantly higher than the level of T0.There was a significant difference between the two groups.There was no significant difference in anesthetic effect and the effect of muscle relaxation between the two groups.Sedation score,VAS score of pain after operation,deep vein embolism of lower extremity,cognitive impairment and other complications,scores in the control group were significantly higher than those in the observation group and there were significant difference between the two groups.Conclusion The combined spinal-epidural anesthesia has a better anesthetic effect in lower limb fracture surgery of elderly patients,and it hardly has influence on hemodynamics during the perioperative period and it can reduce stress reaction with a lower incidence of adverse reactions and good safety.
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