老年初发非嵌顿性腹股沟疝开放性手术患者的麻醉

目的研究老年原发非嵌顿性腹股沟疝开放性手术患者的最佳麻醉方式及临床意义。 方法选取2014年11月至2016年11月，湛江市第二人民医院接受手术治疗的老年原发非嵌顿性腹股沟疝患者662例，其中男性604例，女性58例，平均年龄（68.8±5.4）岁。将全部患者随机分为3组并各自采用全身麻醉（全麻组221例）、椎管内麻醉（椎管内组221例）以及局部麻醉（局麻组220例）。对比3组患者的手术时间、手术加麻醉时间和术中出血量；对比3组患者术后并发症发生情况及并发症率；对比3组患者的术后住院时间以及住院总费用。 结果全麻组、椎管内组、局麻组手术时间分别为（95.32±32.07）、（90.24±28.17）、（89.41±27.52）min，差异无统计学意义（P>0.05）；手术加麻醉时间上局麻组（101.29±32.71）min则显著低于椎管内组的（129.62±39.75）min和全麻组的（149.67±51.38）min，差异有统计学意义（P<0.05）；局麻组的尿潴留发病率3.63%（8/220）显著低于椎管内组13.12%（29/221）和全麻组23.53%（52/221），差异有统计学意义（P<0.05）；局麻组在术后住院时间及住院总费用（4.35±2.41）d、（6 259.76± 773.59）元显著低于椎管内组（6.53±3.25）d、（7 653.26±861.27）元和全麻组（6.82±2.94）d、（9 135.32±896.81）元，差异均有统计学意义（P均<0.05）。 结论局部麻醉是老年原发非嵌顿性腹股沟疝开放性手术患者最佳的麻醉方式。

Optimal anesthesia method for open inguinal hernia repair in elderly patients with primary non-incarcerated inguinal hernia

ObjectiveTo investigate the optimal anesthesia method for open primary non- incarcerated inguinal hernia repair in elderly patients. MethodsA total of 662 patients with primary non-incarcerated inguinal hernia were enrolled in the Zhanjiang second people's hospital from November 2014 to November 2016. The average age was 68.8±5.4 years old, including 604 males and 58 females. All patients were randomly divided into three groups using general anesthesia (n=221), spinal anesthesia (n=221) and local anesthesia (n=220), respectively. The operation time, operation plus anesthesia time and intraoperative blood loss were compared between the three groups. The postoperative complications and the complication rate were compared between the three groups. The postoperative hospital stay and the total cost of hospitalization were compared between the three groups. ResultsThere was no significant difference between the three groups in the operation time (P<0.05). The operation plus anesthesia time in the local anesthesia group (101.29±32.71) was significantly lower than that in the spinal canal group (129.62±39.75) and the general anesthesia group (149.67±51.38), the difference was statistically significant (P<0.05). The incidence of urinary retention in the local anesthesia group was significantly lower than that in the spinal canal and the general anesthesia group (P<0.05). The postoperative hospital stay and the total cost of hospitalization were also significantly lower than those in other two groups, the difference was statistically significant (P<0.05). ConclusionLocal anesthesia is the preferred method of anesthesia open inguinal hernia repair in elderly patients with primary non-incarcerated inguinal hernia.