腰-硬联合麻醉与静脉全身麻醉在髋部手术中应用的比较

目的:比较腰-硬联合麻醉与静脉全身麻醉(全麻)在髋部手术中的应用效果。方法:将120例择期髋部手术患者随机分为腰-硬联合麻醉组(联合组)和全麻组,各60例。联合组选L2-3或L3-4间隙,用腰硬联合穿刺套件行腰硬联合阻滞;全麻组行快诱导气管插管全麻,微量泵静脉持续输入丙泊酚、芬太尼。在麻醉前、麻醉后5 min、术毕及术后1、6、12、24 h时,监测2组患者的血压、心率、脉搏氧饱和度,并比较2组患者在接受相应麻醉时的舒适度、术后VAS评分及麻醉费用。结果:联合组在麻醉操作过程中患处疼痛率明显高于全麻组(P0.01);术中2组生命体征均维持在正常范围内,但联合组术中血压、心率均低于静脉全麻组(P0.01),直至术后12、24 h,2组血压、心率差异无统计学意义(P0.05);2组脉搏氧饱和度差异无统计学意义(P0.05);联合组VAS评分在术后6 h内明显低于全麻组(P0.01),6 h后2组VAS评分差异无统计学意义(P0.05),联合组麻醉费用明显低于静脉全麻组(P0.01)。结论:腰-硬联合麻醉和静脉全麻用于髋部手术时各有利弊,应根据患者情况选择合适的麻醉方法。

Comparison of combined spinal-epidural anesthesia and intravenous general anesthesia in hip surgery

Objective:To compare the effects of combined spinal-epidural anesthesia(CSEA) and intravenous general anesthesia(IGA) during hip surgery. Methods:One hundred and twenty patients were evenly divided into two groups.One group received CSEA and the other IGA.The blood pressure,heart rate,pulse oxygen saturations and VAS marks of the two groups were recorded at 5 minutes after anesthesia,at the end of operation and at 1,6,12 and 24 hours after operation;the comfort level and the anesthesia cost were also compared. Results:The pain rate in CSEA group was much higher than that in IGA group(P<0.01);the vital signs were normal in both groups during operation;the heart rate and blood pressure of CSE group were lower than those of IGA group within 12 hours after operation(P<0.01),but the difference was not significant 12 and 24 hours later(P>0.05);the VAS of CSEA group was obviously lower than that of IGA group within 6 hours after operation(P<0.01);the anesthesia cost of CSEA group was much lower than that of IGA group(P<0.01). Conclusions:Both of the anesthesia methods have their own advantages,and doctors should make a choice according to patients′ physical conditions.