腰硬联合麻醉用于高龄病人髋部骨折的研究

目的:研究腰硬联合麻醉用于高龄病人髋部骨折的可行性。方法:60岁以上高龄髋部骨折择期手术192例,ASA分级Ⅱ~Ⅲ级,随机分为两组,试验组为腰硬联合麻醉(CSEA),称Ⅰ组,104例,由于药物选择的不同又分为布比卡因组Ⅰa和左旋布比卡因组Ⅰb;对照组采用硬膜外阻滞麻醉(EA)称Ⅱ组,88例。观察麻醉平面达T10的时间,最高阻滞平面,麻醉用药总量,追加量,镇痛效果,是否辅助用药,及各项生理指标的检测。结果:Ⅰ组阻滞平面达T10所用时间明显短于Ⅱ组(P<0.05);最高阻滞平面两组无差异;所用麻醉药总量Ⅰ组明显少于Ⅱ组(P<0.05);Ⅰ组追加量显著少于Ⅱ组(P<0.05);Ⅰ组镇痛效果全优,Ⅱ组镇痛效果优:79例,良:9例;辅助用药Ⅰ组明显少于Ⅱ组(P<0.05);收缩压下降>35%的以Ⅱ组为多,且有显著性差异(P<0.05)。而此研究中Ⅰa、Ⅰb组无明显差异。结论:腰硬联合麻醉用于高龄髋部骨折的病人是安全可行的。

The Study of Combined Spinal and Epidural Anesthesia for Senile Hip Joint Fracture

Objective: To study the feasibility of the combination of spinal with epidural anesthesia for senile hip joint fracture.Methods:Altogether 192 cases of ASA physical status Ⅱ～Ⅲ senile hip joint fracture undergoing selective surgery were randomly divided into two groups.Group Ⅰ(104 cases) was performed combined spinal-epiduaral analgesia(CSEA).Group Ⅰa and group Ⅰb was performed combined spinal-epidural anesthesia with the use of bupivacaine and levobupivacaine in spinal anesthesia respectively.Group Ⅱ(88 cases) was performed epidural anesthesia only.During the induction,the sense blockage effective time to T10 and the maximum sensory spread were observed;the total dosage and the additional dosage of anesthetic drugs was assessed;the anesthesia efficacy was evaluated;if assistant drug was used;the change of respiration and circulation after anesthesia was monitored.Results:The sense blockage effective time at T10 was significantly shorter in group Ⅰ than that in group Ⅱ(P<0.05).There were no significant difference(P>0.05) in the maximum sensory spread.The total dosage and the additional dosage of anesthetic drugs were both significantly less in group Ⅰ than that in group Ⅱ(P< 0.05).The anesthesia efficacy was excellent in all cases of group Ⅰ;79 cases in group Ⅱwas excellent,9 cases in group Ⅱwas good.The assistant drugs was significantly less in group Ⅰ than that in group Ⅱ(P< 0.05).Group Ⅰ showed less affection to the respiratory and cardiovascular function than group Ⅱ.Conclusion:The combined spinal-epiduaral analgesia(CSEA) is safe,effective and feasible for senile hip joint fracture.