腰-硬联合麻醉与硬膜外麻醉在老年髋关节置换术中的临床对比研究

目的 探讨腰-硬联合麻醉与硬膜外麻醉在老年患者髋关节置换术中的临床疗效对比研究。方法 选择我院2009年4月-2011年4月40例行髋关节置换术的老年患者，随机分为腰-硬联合麻醉组（A组，n=20）和硬膜外麻醉组（B组，n=20），监测麻醉起效时间，评价麻醉效果，记录麻醉前和麻醉后5min、10min、30min时平均动脉斥（MAP）、心率（HR），记录两种麻醉方式对患者血流动力学的影响，术中两组使用镇静药、血管活性药物例数；记录术后疼痛（VAS评分），比较两种麻醉方式对术后疼痛的影响，同时记录不良反应。结果 两组患者均成功结束手术，A组麻醉起效时间短于B组，差异有统计学意义（P〈0．05），两组麻醉前和麻醉后5min、10min、30min时MAP差异无统计学意义（P〉0．05），A组使用镇静剂少于B组，升压药例数多于B组；VAS评分A组小于B组，差异有统计学差异（P〈0．05）。结论 两种麻醉方式对循环波动均相对较小，但腰-硬联合麻醉起效快，较硬膜外麻醉使用镇静剂较少，术后镇痛效果好，适合老年患者髋天节置换术。

The Clinical Comparative Study on Lumbar-epidural Anesthesi and Epidural Anesthesia in Senile Total Hip Arthroplasty

Objective To investigate lumhar-epidural anesthesia and epidural anesthesia in senile total hip arthroplasty. Methods All 40 cases of hip arthroplasty in elderly patients were divided into the lumbar-epidural anesthesia group （A,n=20）and epidural anes thesia group （B,n=20）from April 2009 to April 2011. Recording the onset time of anesthesia. Monitoring the mean arterial pressure （MAP）,heart rate （HR）before and after anesthesia 5min,10min,30min anesthesia. Recording the number cases of sedative and vasoac tive drugs. Results The anesthesia onset time of A group was shorter than B group,the difference was statistically significant（P〈0.05）. The MAP of two groups before and after anesthesia 5min,10min,30min was no statistically significant （P〉0.05）. A group had less seda tives than B group,but more vasopressors more than the number of cases in B group. The VAS score was less in B group and the difference was statistically significant（P〈0.05 ）. Conclusion Two kinds of anesthesia methods were relatively small on hemodynamie,but the effective time of lumbar-epidural anesthesia was shorter than epidural anesthesia. Meantime,the use of sedatives drugs was less. It is suitable for elderlv patients with hid replacement surgery.