腰硬联合麻醉在90岁以上老年患者股骨粗隆间骨折手术的临床观察

目的：：探讨腰硬联合麻醉在90岁以上老年患者股骨粗隆间骨折手术的应用效果。方法：选择48例90岁以上择期行股骨粗隆间骨折手术者，观察组予以腰麻－硬膜外联合麻醉，对照组予以硬膜外麻醉，每组各24例。观察两组患者手术情况、不同时间点血压与心率变化以及分别采用针刺法进行感觉阻滞评估，改良Bromage评分法进行运动阻滞评价。结果：与对照组比较，观察组患者的麻醉起效时间、用药量均降低明显，差异有统计学意义(P<0.05)，感觉运动阻滞中的起效时间缩短明显，最大感觉阻滞平面以及最大感觉阻滞时间均增加明显，运动阻滞中的起效时间、最大运动阻滞时间均缩短明显，差异有统计学意义( P<0.05)。在T0~4时间段上两组患者的DBP、SBP 以及HR比较均无统计学意义( P>0.05)。结论：在90岁以上老年患者股骨粗隆间骨折手术中应用腰硬联合麻醉不仅用药量低，可较好的维持术中血压以及心率，效果确切，而且可对于感觉与运动进行有效阻滞，安全性较高。

Clinical Observation of Adopted Lumbar Anesthesia Combined with Epidural Anesthesia on Intertrochanteric Fracture Femur Operation Patients Above 90 Years Old Elderly

Objective:To discuss the effect of adopted lumbar anesthesia combined with epidural anes-thesia on intertrochanteric fracture femur operation above of patients 90 years old elderly. Methods:48 cases above 90 years old elderly patients adopted intertrochanteric fracture femur operation were selected, observa-tion group patients were adopted lumbar anesthesia combined with epidural anesthesia, control group patients were adopted epidural anesthesia, 24 cases in each group. operation status, blood pressure and heart rate changes at different time point patients of two groups were observed and separately adopted needle point meth-od to evaluate sensory block, improved Bromage grading method to get through motor block evaluation. Re-sult: Compared with control group, anesthesia time, dosage patients observation group all obviously de-creased, the differences had statistical significances (P<0.05), sensory motor block onset time obviously shorten, maximum sensory block plane and maximum sensory block time all obviously increased, onset time, maximum sensory block time at motor block all obviously shorten, the differences had statistical significances (P<0.05). At T0~4 time point, compared two group patients’ DBP, SBP and HR, the differences all hadn’ t statistical significances ( P>. 05 ) . Conclusion: In the 90 years old patients with femoral intertrochanteric fracture operation in combined spinal epidural anesthesia is not only low dosage, and can better maintain the intraoperative blood pressure and heart rate, the exact effect, but also can effectively block for sensory and motor, high security.