| 腰丛-坐骨神经阻滞及腰硬联合麻醉在高龄病人股骨头置换术中的麻醉效果分析 |
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| 引用本文： | 唐巨.腰丛-坐骨神经阻滞及腰硬联合麻醉在高龄病人股骨头置换术中的麻醉效果分析[J].蚌埠医学院学报,2020,45(1):64-66, 70. |
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| 作者姓名： | 唐巨 |
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| 作者单位： | 四川省宣汉县人民医院 麻醉科, 636150 |
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| 摘 要： | 目的探讨高龄病人股骨头置换术中实施腰丛-坐骨神经阻滞及腰硬联合麻醉的麻醉效果差异。方法选取78例病人为研究对象，按麻醉方式的不同将其分为2组，实施腰硬联合麻醉的39例为腰硬组，实施腰丛-坐骨神经阻滞麻醉的39例为神经阻滞组。观察2组麻醉阻滞前后的血流动力学变化、疼痛视觉模拟量表（VAS）评分，术中血管活性药物及镇痛药物的使用情况。结果麻醉前，2组病人血压和心率比较差异均无统计学意义（P>0.05），经不同阻滞后，2组病人心率及舒张压差异均无统计学意义（P>0.05），但收缩压神经阻滞组显著高于腰硬组（P < 0.01）。且麻醉后2组血压均较麻醉前下降（P < 0.05~P < 0.01），腰硬组心率较麻醉前下降（P < 0.05），神经阻滞组麻醉前后心率差异无统计学意义（P>0.05）。经麻醉后，腰硬组VAS评分明显低于神经阻滞组（P < 0.01）；2组VAS评分均显著低于麻醉前（P < 0.01）。腰硬组术中麻黄碱用量、补液量均显著多于神经阻滞组（P < 0.01），腰硬组术中镇痛药物用量少于神经阻滞组（P < 0.05）。结论腰丛-坐骨神经阻滞及腰硬联合麻醉均可用于高龄病人股骨头置换术，2种麻醉方式对病人血流动力学均无明显影响，其中腰硬联合麻醉术中镇痛药物用量少，镇痛效果显著，在实际临床麻醉中应充分考虑病人实际情况选择合适的麻醉方式。
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| 关 键 词： | 股骨头置换术 高龄 腰丛-坐骨神经阻滞 腰硬联合麻醉 |
| 收稿时间： | 2017-01-03 |
Comparsion analysis of the anesthetic effects between lumbar plexus-sciatic nerve block and combined spinal-epidural anesthesia in elderly patients treated with femoral head replacement |
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| Affiliation: | Department of Anesthesiology, Xuanhan People's Hospital, Xuanhan Sichuan 636150, China |
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| Abstract: | ObjectiveTo investigate the differences of anesthesia effects between lumbar plexus-sciatic nerve block and combined spinal-epidural anesthesia in elderly patients treated with femoral head replacement.MethodsA total of 78 patients treated with femoral head replacement were divided into two groups according to different anesthesia methods.Thirty-nine patients treated with combined lumbar-epidural anesthesia and 39 cases treated with lumbar plexus-sciatic nerve block were divided into the spinal-epidural group and nerve block group, respectively.The hemodynamic changes and VAS score before and after anesthesia, intraoperative vasoactive drugs and analgesic drugs were observed in two groups.ResultsThere was no statistical significance in blood pressure and heart rate between two groups before anesthesia (P>0.05).After anesthesia, the difference of the heart rate and diastolic blood pressure between two groups were not statistically significant (P>0.05), and the level of systolic pressure in nerve block group was higher than that in spinal-epidural group (P < 0.01).After anesthesia, the blood pressure levels in two groups decreased compared with before anesthesia (P < 0.05 to P < 0.01), the heart rate in spinal-epidural group decreased compared with before anesthesia (P < 0.05), and the difference of the heart rate in nerve block group was not statistically significant between before and after anesthesia (P>0.05).After anesthesia, the VAS score in spinal-epidural group was significantly lower than that in nerve block group (P < 0.01), and the VAS scores in two groups were significantly lower than those before anesthesia (P < 0.01) The amount of intraoperative ephedrine and fluid supplementation in spinal-epidural group were significantly higher than those in nerve block group (P < 0.01), and the amount of intraoperative analgesic drugs in spinal-epidural group was lower than that in nerve block group (P < 0.05).ConclusionsLumbar plexus-sciatic nerve block and combined spinal-epidural anesthesia can be used in elderly patients treated with femoral head replacement.The two anesthesia methods have not significant effects on the hemodynamics of patients, the amount of analgesic drugs in combined spinal-epidural anesthesia is less, and the analgesic effect is significant.In the actual clinical anesthesia, we should fully consider the actual situation of patients to choose the appropriate anesthesia. |
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