预注舒芬太尼、曲马多复合咪达唑仑对老年髋部骨折椎管内麻醉的影响

目的 预注舒芬太尼、曲马多复合咪达唑仑应用于老年髋部骨折手术患者,观察其对椎管内麻醉的影响.方法 选择90例择期老年髋部骨折手术患者,随机分为三组：舒芬太尼组（A组）、曲马多组（B组）和对照组（C组）,每组30例.A组给予舒芬太尼0.05～0.1μg/kg、咪达唑仑0.02 ～ 0.03 mg/kg静脉注射,B组给予曲马多0.5 ～ 1.0 mg/kg、咪达唑仑0.02 ～ 0.03 mg/kg静脉注射,C组给予等容量生理盐水,然后实施椎管内麻醉,观察、记录术中生命体征,记录患者给药后疼痛程度和镇静程度及对椎管内麻醉的影响.结果 A组患者在T1时出现SpO2下降,在T1时A组SpO2明显低于B、C组（P＜0.05）;C组患者HR、MAP在T1、T2时明显快于、高于T0时（P＜0.05）;T1、T2时A、B组HR、MAP明显低于C组（P＜0.05）.结论 在实施椎管内麻醉前,在保证充分给氧的情况下,给予舒芬太尼或曲马多复合咪达唑仑,均可以快速、安全、有效地减轻体位转换和侧卧位时髋部疼痛,并消除患者对麻醉、手术及预后的顾虑和恐惧,有利于椎管内麻醉穿刺,抑制患者应激反应,维持血流动力学稳定.患肢在上,又避免体位反复转换对老年患者血流动力学的影响.

Effects of pre-injection of sufentanil or tramadol with midazolam before spinal anesthesia on hip fracture of the elderly

Objective To observe the effect of pre-injection of sufentanil or tramadol with midazolam before spinal anesthesia on elderly patients with hip fracture undergoing surgery operation.Methods 90 elderly patients scheduled for selective hip fracture operation were randomly divided into three groups：sufentanil group （group A）,tramadol group （group B） and control group （group C）,30 cases in each group,group A was pre-intravenous injected with sufentanil 0.05-0.1 μ g/kg,midazolam 0.02-0.03 mg/kg,group B injected with tramadol 0.5-1.0 mg/kg,midazolam 0.02-0.03 mg/kg,and group C was given the equal volume of physiological saline,spinal anesthesia were implemented afterwards,both vital signs and effects on spinal anesthesia during operation were observed and recorded.Results SpO2 decreased at T1 in group A and lower than those in group B and C at T1 （P ＜ 0.05）; in group C HR and MAP were obviously faster and higher at T1 and T2 than those at T0 （P ＜ 0.05）; in group A and B HR and MAP were obviously lower than those in group C at T1 and T2 （P ＜ 0.05）.Conclusion Before spinal anesthesia,ensuring the supply of sufficient oxygen condition,sufentanil or tramadol combined with midazolam can fast,safely and effectively alleviate pain when changing body position and being lateral position,and eliminate the patients＇ worry and fear about anesthesia,operation and prognosis,they can also improve spinal anesthesia puncturing,inhibit the stress response,and maintain hemodynamic stability.As the affected limb up on,the effect can be avoided on hemodynamics in elderly patients when repeating changing position.