高龄髋关节手术不同椎管内麻醉方式的对比研究

目的：通过对比高龄髋关节手术最常用的3种椎管内麻醉方式的疗效和安全性，为此类手术的麻醉选择提供参考。方法：从高龄髋关节手术的病例中，随机抽取75例并分成3组，即持续硬膜外麻醉组（Ⅰ组，n=25），重比重液腰硬联合麻醉组（Ⅱ组，n,=25）和轻比重液单侧腰麻复合硬外麻醉组（Ⅲ组，n=25）。均选L2-3为穿刺点，分别予3种不同的麻醉方法，统计3种方法的麻醉起效时间、麻醉平面、运动神经阻滞和恢复时间、麻醉效果、生命体征变化情况及不良反应等。结果：Ⅱ组和Ⅲ组的麻醉成功率比Ⅰ组高，麻醉效果更完善；麻醉起效以Ⅱ组最快，Ⅰ组最慢；麻醉平面以Ⅲ组控制得最好；麻醉后低血压以Ⅰ组最多，Ⅲ组最轻。结论：高龄髋关节手术选择轻比重液单侧腰麻复合硬外麻醉的方法最理想，尤其适合于高龄髋关节手术的危重患者。

Comparative study on hip surgery in senile patients with different anesthesia via vertebra tube

Objective:To compare the effect and safety of hip surgery in senile patients with three anesthesia ways via vertebra tube,and to provide reference for anesthetic selection for surgery of this kind in the future. Methods:75 cases were radomly divided into three groups,continuous epidural anesthesia group (group I,n=25),combined spinal-epidural anesthesia group with hyperbaric solution (group II,n=25),and combined single spinal-epidural anesthesia group with hypobaric solution (group III,n=25). L2-3 was selected as the puncture potion for the three groups which were treated with three different anesthetic methods respectively. Onset time,level of anesthesia,block and recovery time of motor nerves,effect of anesthesia,changes of vital signs and adverse effect were compared. Results:Success rates of group II and III were higher than that of group I. The effects of anesthesia in group II and III were more satisfactory than that in group I. The onset time of group II was the shorter while group I was the longest. The level of anesthesia in group III was controlled better than that in other groups. Hypotension after anesthesia most appeared in group I,while least in group III. Conclusion:Combined single spinal-epidural anesthesia group with hypobaric solution is the optimal method for hip surgery in senile patients,especially for critical patients.