小剂量轻比重不同浓度罗哌卡因单侧腰-硬联合麻醉在老年患者全髋关节置换术中的应用研究

目的：分析探讨小剂量、轻比重、等容量不同浓度罗哌卡因单侧腰-硬联合麻醉在治疗70岁以上老年患者全髋关节置换术中的效果。方法选取90例在我院接受全髋关节置换术的70岁以上患者,将其随机分为Ⅰ、Ⅱ、Ⅲ组,每组患者30例。对Ⅰ组患者采用0.75%罗哌卡因1ml+4ml注射用水配制成0.15%罗哌卡因,Ⅱ组患者采用0.75%罗哌卡因1ml+2ml注射用水配制成0.25%罗哌卡因,Ⅲ组患者采用0.75%罗哌卡因1ml+1ml注射用水配制成0.5%罗哌卡因,观察三组患者的镇痛起效时间、麻醉持续时间、痛觉及运动恢复时间、手术中出血量及不良反应发生情况。注射剂量为3ml。结果Ⅲ组和Ⅱ组患者的麻醉持续时间较Ⅰ时间长,痛觉及运动恢复时间随浓度增加而逐渐延长,手术中出血量Ⅲ组患者明显多于Ⅱ组患者。三组间比较具有统计学意义(P<0.05)。结论70岁以上老年患者在全髋关节置换术中采用剂量为0.25%的罗哌卡因3ml最为适宜,在轻比重、等容量前提下,0.25%罗哌卡因较0.15%罗哌卡因有效,较0.5%罗哌卡因安全。     

不同比重的布比卡因腰硬联合麻醉在剖宫产手术中的应用

目的观察重比重与等比重布比卡因腰硬联合的麻醉在剖宫产手术中麻醉效果。方法根据ASA标准将60例Ⅰ～Ⅱ级产妇随机分为重比重组和等比重组各30例。重比重组于L3～L4椎间隙腰穿,针斜面朝头侧,注入0.5%重比重布比卡因（0.75%布比卡因2 mL加10%葡萄糖1 mL混合液）1.8 mL,注射速度为0.2 mL/s,等比重组注入0.5%等比重布比卡因（0.75%布比卡因2 mL加0.9%生理盐水1 mL混合液）1.8 mL,注射速度为0.2 mL/s。分别于注药后2、5、10、15、20、25、30 min记录镇痛平面和下肢运动阻滞程度。结果等比重镇痛与运动阻滞维持时间明显短于重比重组（P〈0.05）,等比重组镇痛满意率和麻醉阻滞平面明显低于重比重组（P〈0.05）,两组的麻醉并发症和新生儿评分无显著差异。结论重比重布比卡因更适于剖宫产手术的麻醉。     

两种麻醉方式用于髋关节置换术的临床比较

目的：分析腰-硬联合麻醉和硬膜外麻醉两种不同的麻醉方式在髋关节置换手术中的临床疗效。方法选择2012年2月~2014年4月在我院住院行髋关节置换手术的患者共计140例,随机分为腰-硬联合麻醉组和硬膜外麻醉组,每组各70例,比较两组间麻醉前后的血压、心率等指标,及麻醉时间、效果和术后并发症情况。结果组间麻醉前后的血压、心率变化差异无统计学意义;腰-硬联合麻醉组麻醉时间明显缩短,麻醉效果优于硬膜外麻醉(P<0.05);两组术后均无严重并发症出现。结论对于髋关节置换术的治疗易采用腰-硬联合麻醉方式。     

罗哌卡因腰硬联合麻醉在高龄下肢手术中的应用

目的 探讨罗哌卡因腰麻-硬膜外联合阻滞麻醉在高龄患者下肢手术中应用安全性.方法 选择80例高龄患者下肢择期手术,穿刺点L2～L3或L3～L4局麻药10%葡萄糖配制的0.5%罗哌卡因重比重液1.0～1.5mL,头置管平面控制T10以下.结果 SBP、MAP、HR、SpO2与麻醉前比差异无显著性,麻醉效果满意,术中术后无恶心、呕吐、头痛,尿潴留发生.结论 罗哌卡因腰麻-硬膜外联合麻醉在高龄患者下肢手术中是安全可靠的.     

轻比重罗哌卡因腰硬联合麻醉用于老年下肢手术

目的：观察轻比重罗哌卡因腰硬联合麻醉用于老年下肢手术的麻醉效果。方法将60例60岁~90岁的老年下肢手术患者(手术类型为股骨、膝关节、胫腓骨骨折等骨科下肢手术),ASA分级为Ⅱ级,排除晕动症、心脑血管病患者。随机分成两组,对照组给予重比重罗哌卡因麻醉,观察组给予轻比重罗哌卡因麻醉,比较两组麻醉效果、血液动力学指标变化、麻醉不良反应的差异。结果两组感觉阻滞起效时间、感觉阻滞恢复时间比较,麻醉效果比较,差异无统计学意义(P>0.05)。与对照组相比,观察组血流动力学指标波动程度低,差异有统计学意义(P<0.05);与对照组比较,观察组不良反应发生率明显低,差异有统计学意义(P<0.05)。结论罗哌卡因腰原硬联合麻醉可以取得良好的麻醉效果,其中轻比重罗哌卡因对血液动力学影响小、不良反应少,安全性更高。     

腰-硬联合麻醉与硬膜麻醉用于高龄患者髋关节手术的应用比较

目的 探讨腰--硬联合麻醉(CSEA)用于70岁以上患者髋关节手术应用的可行性.方法 选择70~90岁行髋关节人工假体置换术患者50例,随机分为CSEA组(A组)和硬膜外麻醉组(B组),观察并记录术中输液,输血量,麻醉平面上升速度,局麻药用量,达到T10阻滞时间,麻醉效果,术中MAP,HR变化及术后不良反应.结果 A组麻醉平面上界达到T10阻滞时间为(3.9±0.6)min,明显短于B组的(13.0±1.5)min(P<0.01).A组给予硬膜外试验后未再追加局麻药,局麻药用量明显少于B组(P<0.01)A组患者对术中镇痛均感满意,B组有6例患者对术中镇痛不能接受,麻醉满意率A组100%,B组为76%.结论 两组患者麻醉过程顺利,术后情况良好,均无明显的麻醉后并发症.     

腰硬联合麻醉在高龄人工髋关节置换手术中的应用

目的探讨腰硬联合麻醉在高龄人工髋关节置换手术中应用的可行性和安全性。方法64例高龄择期手术患者ASAⅡ-Ⅲ级,随机分为腰硬联合麻醉（Combinedspinal and epidural anesthesia,CSEA）组和连硬外麻醉（continuous epidural anesthesia,CEA）组。观察麻醉效果及对血流动力学影响。结果CSEA麻醉起效快,镇痛效果满意,对血流动力学影响小,与CEA组比较有显著性差异（P〈0．05）。结论CSEA可安全有效地应用于高龄人工髋关节置换手术。     

小剂量布比卡因-芬太尼腰硬联合麻醉在急诊剖宫产术中的应用

目的 探讨较小剂量布比卡因复合芬太尼腰硬联合麻醉行剖宫产术的临床效应.方法 40例行急诊剖宫产术的临产妇,随机双盲分为两组.A组腰麻用药为布比卡因6mg加芬太尼20μg(n=20);B组布比卡因10mg(n=20).观察两组用药后的MAP和HR变化、新先儿Apgar评分、麻醉效果及不良反应.结果 B组MAP比A组下降更加显著,B组低血压发生率明显高于A组(P<0.01);两组新生儿Apgar评分无差异(P>0.05);A组麻醉效果明显优于B(P<0.01);两组不良反应无显著差异.结论 较小剂量布比卡因复合芬太尼腰硬联合麻醉行急诊剖宫产术,麻醉效果确切,低血压发生率低且不良反应少.     

不同浓度布比卡因腰硬联合麻醉用于剖宫产手术的对比观察

腰硬联合麻醉具有起效快、镇痛完善、肌松满意等优势,现已广泛应用于剖宫产手术,但相对于单纯硬膜外麻醉,更容易出现难以解释的神经损伤等并发症。我们期望通过适当降低布比卡因的浓度,而减少腰硬联合麻醉后神经损害并发症的发生率。因此我们将布比卡因蛛网膜下腔注射的浓度调整到0.4%,与常规使用的浓度0.5%进行对比观察,     

Prehospital education: effectiveness with total hip replacement surgery patients

In-hospital education can reduce anxiety, improve coping and shorten hospital stays of surgical patients. However, hospitals are containing costs by shortening pre- and postoperative stays and reducing the time available for in-hospital teaching. This study evaluated prehospital education for total hip replacement (THR) surgery. Half of the patients waiting for admission for THR surgery were randomly selected to receive a THR education booklet in the mail 4–6 weeks before their scheduled THR surgery. Compared to the No-Booklet patients, patients who had received the booklet were less anxious at the time of hospital admission and at discharge, were more likely to have practised physiotherapy exercises prior to hospitalization, and required significantly less occupational therapy and physiotherapy while in hospital. There were no group differences for length of hospital stay.     

人工假体置换治疗高龄股骨转子间骨折的疗效及原理

目的：探讨人工假体置换治疗高龄股骨转子间不稳定性骨折的疗效及原理。方法：采用人工假体置换手术治疗75岁以上高龄老人(平均82．5岁)不稳定性股骨转子间骨折37例。其中Evans Ⅲ型9例，Ⅳ型23例，V型5例。其中30例(81％)合并3种以上并存症，并存症中以心血管疾病为主，其次为糖尿病，脑血管病。结果：本组病例无1例术中或住院期间死亡，平均随访18个月。入院至手术时间5～7d，平均6．5d。手术时间45～80min，平均60min，术中输血2～8单位红细胞(平均4单位红细胞)。住院时间20～30d(平均24d)：伤口一期愈合，未见感染，松动，脱位者。结论：①人工假体置换治疗高龄股骨转子间不稳定性骨折，具有有效止痛，早期离床，并发症少，死亡率低的优点，疗效令人满意；②术后可负重而没有骨折局部塌陷的危险，利于早期康复；③应严格掌握其适应症，强调围手术期的正确处理。     

抑肽酶血液麻醉在关节置换外科手术中的应用

目的探讨抑肽酶血液麻醉在关节置换外科手术中的使用价值及对凝血功能的影响。方法60例择期行骨科关节置换手术病例,随机分为两组。实验组30例,在麻醉诱导后静注抑肽酶200万K IU后持续泵注抑肽酶50万K IU/h,直至手术后结束停药;对照组30例,持续泵注生理盐水。分别在术前、木毕、术后6 h、24 h时间点上抽血检测血常规、血栓弹性描记图（TEG）、凝血功能指标。比较两组病人的出血量、输血量及TEG和凝血功能变化。结果在使用了抑肽酶之后,手术时间明显缩短;两组手术出血量及输异体血量比较,有非常显著性差异（P〈0.01）。抑肽酶对A组的F ib、TEG指标无显著性影响（P〉0.05）。结论抑肽酶血液麻醉可明显减少关节置换外科手术的出血量,减少异体血的输入,且不影响凝血功能,值得推广应用。     

双髋关节动力髋置换过程中3种麻醉药物的比较

背景：关于小花猪实验麻醉方面的文献报道较少,且部分文献报道不同麻醉药物在实验中效果不是很理想。 目的：比较双髋关节动力髋置换过程中单药麻醉与不同联合麻醉对小花猪的麻醉效果。 方法：18头小花猪随机分为3组,速眠新Ⅱ单药组颈部肌肉注射速眠新Ⅱ(0.2 mL/kg),速眠新Ⅱ+戊巴比妥钠组在双侧颈部肌肉分开注射速眠新Ⅱ(0.2 mL/kg)与戊巴比妥钠(15 mg/kg),速眠新Ⅱ+氯胺酮组于一侧颈部肌肉注射速眠新Ⅱ(0.2 mL/kg)与氯胺酮(10 mg/kg)混合液。麻醉后行双髋关节动力髋置换。 结果与结论：速眠新Ⅱ单药组诱导期较其他2组持续时间长(P < 0.05),麻醉期较其他2组持续时间短(P < 0.05);苏醒期各组之间两两比较差异均有显著性意义(P < 0.05)。速眠新Ⅱ+氯胺酮组呼吸频率较其他2组增快(P < 0.05),速眠新Ⅱ+戊巴比妥钠组心率较其他2组增快(P < 0.05);速眠新Ⅱ单药组及速眠新Ⅱ+氯胺酮组收缩压较速眠新Ⅱ+戊巴比妥钠组高(P < 0.05);速眠新Ⅱ+戊巴比妥钠组休克指数较其他2组增高(P < 0.05)。提示联合用药比单药麻醉效果好,速眠新Ⅱ与氯胺酮联合较速眠新Ⅱ与戊巴比妥钠联合麻醉诱导快、维持效果好、安全性高且置换后苏醒快,是比较理想的麻醉方法。     

Videotape preparation of patients before hip replacement surgery reduces stress

OBJECTIVE: Elective surgery represents a considerable source of stress for the patient. Many attempts have been made to prepare patients before surgery with the aim of reducing stress and improving outcome. This study used a novel approach to fulfill this aim by showing a videotape of a patient undergoing total hip replacement surgery, covering the time period from hospital admission to discharge, that strictly keeps to the patient's perspective. METHODS: Before elective total hip replacement surgery, 100 patients were randomly assigned to a control group or a preparation group; the latter group was shown the videotape on the evening before surgery. Anxiety and pain were evaluated daily for 5 days, beginning with the preoperative day, by means of the State-Trait Anxiety Inventory and a visual analog scale. Intraoperative heart rate and blood pressure, as well as postoperative intake of analgesics and sedatives, were recorded. Urinary levels of cortisol, epinephrine, and norepinephrine were determined in 12-hour samples collected at night for 5 nights, beginning with the preoperative night. RESULTS: Compared with the control group, the preparation group showed significantly less anxiety on the morning before surgery and the mornings of the first 2 postoperative days, and significantly fewer of them had an intraoperative systolic blood pressure increase of more than 15%. The pain ratings did not differ significantly between the two groups, but the prepared patients needed less analgesic medication after surgery. Prepared patients had significantly lower cortisol excretion during the preoperative night and the first 2 postoperative nights. Excretion of catecholamines did not differ significantly between groups. CONCLUSIONS: We conclude that use of the videotape decreased anxiety and stress, measured in terms of urinary cortisol excretion and intraoperative systolic blood pressure increase, in patients undergoing hip replacement surgery and prepared them to cope better with postoperative pain.     

围手术期血液管理与中药八珍汤对老年关节置换后血红蛋白及高凝状态的影响

BACKGROUND: Perioperative blood management has been extensively used in orthopedic clinic. However, how the combination of traditional Chinese medicine and perioperative blood management influences the blood biochemical indexes and hypercoagulability after major operation is rarely reported.     

Predictors of hip joint replacement in new attenders in primary care with hip pain.

BACKGROUND: Studies investigating the factors associated with need for total hip replacement should ideally be based on prospective investigation of new attenders in primary care. AIM: To determine the incidence of listing for total hip replacement, and its predictors, among attenders in primary care with a new episode of hip pain. DESIGN OF STUDY: Prospective multicentre cohort study. SETTING: One hundred and ninety-five patients (mean age = 63 years, 68% female) with new episode of hip pain, attending primary care between November 1994 and October 1997. At the first visit, patients were evaluated for indices of pain and disability, range of hip movement, and radiographic changes of osteoarthritis. METHOD: General practitioner participants were recruited from the membership of the Primary Care Rheumatology Society to recruit all consecutive attenders with a new episode of hip pain. Annual follow-up was carried out to determine which patients were being 'put on a waiting list' for total hip replacement. RESULTS: Seven per cent of patients were put on a waiting list for total hip replacement within 12 months and 23% of patients within four years. At presentation, pain duration, pain severity, (including the need to use a stick) and restriction of internal rotation were the major clinical predictors of being put on a waiting list. Radiographic predictors of osteoarthritis performed similarly to the clinical measures. A simple scoring system based on both radiographic severity and two of the clinical measures was derived that identified groups at high likelihood of being put on a waiting list (sensitivity = 76%) with a low false-positive rate (specificity = 95%). CONCLUSION: New primary care attenders with pain are frequently accepted for total hip replacement soon after their first attendance--a decision that can be predicted by simple clinical measures.     

Ion release in patients with metal-on-metal hip bearings in total joint replacement: a comparison with metal-on-polyethylene bearings

Polyethylene (PE) wear has been shown to be a problem in long-term joint replacement using metal-on-PE bearing. The use of metallic heads articulating with metallic cups could solve this problem: success will be enhanced if wear and corrosion of the articulating surfaces are maintained at a low level. New models with metal-on-metal bearing have been proposed, to be used mainly for young subjects: such coupling seems to have a reduced release, but it is unclear yet if the medium-term corrosion rate is really negligible or, on the contrary, it is significantly higher than in the metal-on-PE bearing. Aim of our study was the comparison of ion release in the serum of two groups of patients who had the same type of stable cementless prosthesis, but different bearing: twenty-six patients with metal-on-metal (Group A) and fifteen patients with metal-on-PE bearing (Group B) were examined. The follow-up was 14-38 months for group A and 18-34 months for group B. The serum concentration of chromium (Cr), cobalt (Co) and molybdenum (Mo) was measured. Twenty-two patients before surgery were used for comparison (Group C). The reference values were obtained from a population of twenty-two healthy subjects (Group D). Our findings indicate that metal-on-metal bearings produce a significantly higher systemic release of cobalt and chromium (ng/ml) when compared with levels found in metal-on-PE, pre-surgery and reference groups. Such a high release should induce to improve the bearing materials or, at least, to study the biologic fate of metal ions and consequently their long-term effects. In such a way a risk-to-benefit ratio for the patient could be established.