全身麻醉与腰硬联合麻醉在老年股骨颈骨折手术患者中的镇痛效果及安全性探讨

摘要

Objective To investigate the effects and safety of spinal-epidural anesthesia and general anesthesia in gerontal patients with transcervical fracture.Methods 120 gerontal patients with transcervical fracture treated at our hospital from January 2014 to September 2016 were chosen as experimental subjects and were divided into a control group and a research group.The control group took general anesthesia and the research group spinal-epidural anesthesia.The nerve block,anesthetic effect,SpO2,HR,blood pressure,and adverse reactions were compared between these two group.Results The onset time of anesthesia [(7.04±2.92)min vs.(12.86±3.45) min] and VAS [(2.07±0.31) vs.(4.52±0.22)] were lower and the Bromage score [(3.12±0.46) vs.(1.87±0.34)] was higher in the research group than in the control group,with statistical differences (all P ＜ 0.05).There was no statistical difference in the sensory recovery time between these two groups [(2.38±0.45) h vs (2.49±0.38) h,P ＞ 0.05].The excellent rate of anesthesia was higher in the research group than in the control group (98.33％ vs.86.67％),with a statistical difference (P ＜ 0.05).the HR,SBP,and DBP fluctuated less in the research group than in the control group,with statistical differences at T2,T3,and T4 (all P ＜ 0.05).SpO2 fluctuated little in both groups,with no statistical difference (P ＞ 0.05).The incidences of nausea (3.33％ vs.13.33％) and vomiting,dizziness,and drowsiness (5.00％ vs.20.00％) were lower in the research group than in the control group,with statistical differences (P ＜ 0.05).There was no statistical difference in the incidence of other adverse reactions between these two groups (P ＞ 0.05).Conclusion Spinal-epidural anesthesia has better anesthesic effects in gerontal patients with transcervial fracture and has little influence on HR and blood pressure and is safe.%目的 探讨全身麻醉与腰硬联合麻醉在老年股骨颈骨折手术患者中的镇痛效果及安全性.方法 选取本院2014年1月至2016年9月收治的120例老年股骨颈骨折患者进行研究,按随机数字表法将其分为研究组与对照组,对照组患者采用全身麻醉,研究组患者采用腰硬联合麻醉,比较两组患者神经阻滞情况、麻醉效果、血氧饱和度(SpO2)、心率(HR)、血压变化情况、不良反应发生情况.结果 研究组患者麻醉起效时间[(7.04±2.92)min比(12.86±3.45)min]、VAS评分[(2.07±0.31)分比(4.52±0.22)分]均较对照组低,Bromage评分[(3.12±0.46)分比(1.87±0.34)分]较对照组高,差异均有统计学意义(均P＜ 0.05).感觉恢复时间组间比较差异无统计学意义(P＞0.05).研究组患者麻醉效果优良率(98.33％比86.67％)高于对照组,差异有统计学意义(P＜0.05).研究组患者HR、SBP与DBP波动较小,对照组患者波动较大,在T2、T3、T4时比较差异均有统计学意义(均P＜ 0.05).两组患者SpO2均波动较小,组间比较差异无统计学意义(P＞0.05).研究组恶心呕吐(3.33％比13.33％)、头晕嗜睡(5.00％比20.00％)发生率较对照组低,差异均有统计学意义(均P＜ 0.05).其他不良反应发生率比较差异无统计学意义(P＞0.05).结论 腰硬联合麻醉在老年股骨颈骨折患者中麻醉效果、起效速度均优于全身麻醉,对患者心率、血压影响较小,安全性高.