高龄高危髋关节置换术患者的两种麻醉方式比较研究

目的探讨两种麻醉方式对高龄高危髋关节置换术患者的影响,比较麻醉方式的优劣。方法髋关节置换术老年患者30例,ASAⅡ～Ⅲ级,年龄70～96（82.60±8.66）岁,随机分为A、B两组,各15例。A组：小剂量腰硬联合麻醉＋全麻组：L2～3或L3～4蛛网膜下腔注入布比卡因10mg＋10%葡萄糖1mL;依托咪酯0.2mg/kg＋芬太尼0.2mg＋阿曲库铵0.1mg/kg全麻诱导气管插管;丙泊酚2mg/（kg·h）＋瑞芬太尼3ug/（kg·h）静脉泵注维持麻醉。B组：单纯全麻组：依托咪酯0.2mg/kg,芬太尼0.2mg,阿曲库铵0.4mg/kg,全麻诱导气管插管;丙泊酚4～6mg/（kg·h）瑞芬太尼5～10ug/（kg·h）静脉泵注,1%～3%七氟醚吸入维持麻醉,间断给予阿曲库铵12.5mg维持肌松。记录麻醉前、麻醉后5,15,30min和术毕气管拔管时的收缩压,舒张压,CVP,心率,脉搏血氧饱和度;手术结束后5,15,30min的steward苏醒评分和脱氧后的脉搏氧饱和度（SPO2）;计算记录麻醉结束后镇静药、镇痛药和肌松药的消耗总量等。结果手术结束后5,15,30min的steward苏醒评分A组明显高于B组,差异有统计学意义（P〈0.001,P〈0.01,P〈0.05）;手术结束脱氧5min,15min后的脉搏氧饱和度（SPO2）A组明显高于B组,差异有统计学意义（P〈0.05）;麻醉结束后消耗镇静镇痛药和肌松药总量比较A组明显少于B组,差异有统计学意义（P〈0.001）。其他观察指标两组差异无统计学意义（P〉0.05）。结论小剂量腰硬联合阻滞复合全麻用于高龄高危髋关节置换术镇静、镇痛、肌松完善,减少了椎管内和全身麻醉用药,麻醉苏醒快,有利于高龄患者呼吸循环机能稳定。

Study on Comparison of Two Anesthesia M ethods in High Risk Advanced Age patients Undergoing Total Hip Replacement Surgery

Objective To compare the efficacy on two kinds of anesthesia method in high risk advanced age patients undergoing total hip arthroplasty.M ethods Thirty ASA II～III level patients aged 70～96（82.6 ± 8.66） years,undegoing total hip arthroplasty,were randomly divided into small doses of combined spinal-epidural anesthesia combined with general anesthesia group（group A,n=15） and simple general anesthesia group（group B,n=15）.In group A,bupivacaine 10mg and 10% glucose 1mL subarachnoid cavity were injected in L2～3 or L3～4.Etomidate 0.2 mg/kg,fentanyl 0.2 mg,atracurium 0.1 mg/kg were administrated for tracheal intubation under general anesthesia.Remifentanil 3 ug/（kg·h） and propofol 4 mg/（kg·h） were intravenously pumped for anesthesia maintenance.In group B,etomidate 0.2 mg/kg,fentanyl 0.2 mg,atracurium 0.4 mg/kg were administrated for induction and intubation of general anesthesia.Propofol 4～6 mg/（kg·h）,remifentanil 5～10 ug/（kg·h） and 1%～3% sevoflurane inhalation were received for anesthesia maintenance.Atracurium 12.5 mg was discontinuously administrated for muscle relaxant maintenance.The systolic blood pressure（SBP）,diastolic blood pressure（DBP）,CVP,heart rate（HR）,pulse oxygen saturation（SPO2） were recorded at 5,15,30 min before and after tracheal extubation.The Steward awakening score at 5,15,30 min after the operation and SPO2 after deoxidization were also recorded.The consumption of sedatives,analgesics or muscle relaxants at the end of anesthesia were evaluated.Results The Steward awakening score in group A was significantly higher than that in group B（P〈0.05） at 5,15,30 min after the operation;SPO2 after deoxidization in group A was significantly higher than that in group B（P〈0.05） at 5,15 min after the operation.The consumption of sedatives,analgesics and muscle relaxants in group A were less than those in group B at the end of anesthesia（P 0.05）.There were no significant difference in the other observation things（P〈0.05）.Conclusion The small doses of combined spinal-epidural block combined with General anesthesia undergoing total hip arthroplasty for the aged can provide perfection of sedation,analgesia,muscle relaxation,reduce drugs spinal or general anesthesia,promote recovery of anesthesia,and thus is conducive to the stability of respiratory and circulatory function in aged patients.