目的 探讨神经阻滞联合喉罩全麻术中保留自主呼吸在老年患者股骨近端防旋髓内钉(proximol femorol nail anti-rotation, PFNA)手术中的应用.方法 通过对2014年3月—2016年2月解放军第148医院骨关节科实施PFNA手术治疗的110例老年患者临床资料做回顾性分析,并根据麻醉方式的不同分为观察组(采取神经阻滞联合喉罩全麻术麻醉)、对照组(采取单纯全麻麻醉),各55例.比较并分析2组患者入手术室时、麻醉后、手术结束后各时间点的血压、心率变化及术中输液量、在手术室待的时间、患者满意度情况、术后并发症情况、BIS值等.结果 2组患者血压及心率均较入手术室时下降,差异具有统计学意义(P<0.05),且对照组血压、心率较观察组下降明显,差异具有统计学意义(P<0.05),可表明观察组患者血压、心率更为稳定;对照组的术中输液量明显多于观察组,差异具有统计学意义(P<0.05);2组患者手术室停留时间比较无明显,差异无统计学意义(P>0.05);对照组所需的BIS值较观察组低,差异具有统计学意义(P<0.05);观察组的术后并发症总发生率(3.62%)明显低于对照组(29.09%),差异具有统计学意义(P<0.05);观察组的舒适度满意度(92.72%)明显高于对照组(65.45%),差异具有统计学意义(P<0.05);2组费用满意度比较(87.27%vs 90.90%),差异无统计学意义(P>0.05).结论 保留自主呼吸的神经阻滞联合喉罩全麻术在老年PFNA手术患者中应用,麻醉效果好,安全性高,且患者血流动力学稳定,满意度高,是老年PFNA手术患者较为理想的麻醉方法,值得临床推广.%Objective To investigate the applicability of autonomic respiration in PFNA in elderly patients undergoing general anesthesia with nerve blocks combined with laryngeal masks. Methods The clinical data of 110 elderly patients treated with PFNA in the Department of Orthopedic Surgery of our hospital between March 2014 and February 2016 was retrospectively analyzed. The patients were equally divided into the observation group and control group according to the different methods of anesthesia. The observation group was treated with nerve blocks combined with laryngeal mask anesthesia, while the control group was treated with general anesthesia. The blood pressure and heart rate changes of the two groups of patients upon their admission into the operating room, after anesthesia and at the end of the operation, the amount of intraoperative infusion, the time spent waiting in the operating room, patient satisfaction, postoperative complications and BIS values were compared and analyzed. Results The blood pressure and heart rate of the two groups were lower than those upon their admission to the operating room, and the difference was statistically significant(P<0.05). The blood pressure and heart rate in the control group were significantly lower than those in the observation group(P<0.05), indicating that the blood pressure and heart rate of the observation group were more stable.The intraoperative infusion volume of the control group was significantly higher than that of the observation group, and the difference was statistically significant(P<0.05). No significant difference was detected in the residence time in the operating room between the two groups(P>0.05). The BIS values required in the control group were lower than those in the observation group, and the difference was statistically significant(P<0.05). The incidence of postoperative complications(3.62%) in the observation group was significantly lower than that in the control group(29.09%),and the difference was statistically significant(P<0.05). The satisfaction rate(92.72%) in the observation group was significantly higher than that in the control group(65.45%), and the difference was statistically significant(P<0.05). No significant difference was detected in levels of satisfaction with the cost between the two groups(87.27% / 90.90%)(P>0.05). Conclusion The application of artificial nerve blocks combined with laryngeal mask airway anesthesia in elderly patients under PFNA surgery is effective and safe. The hemodynamics of patients is highly stable and satisfactory, which is ideal for elderly patients with PFNA anesthesia and worthy of clinical promotion.
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