两种麻醉方法用于高龄ASAⅢ级患者全髋骨置换术的临床效果比较

摘要

目的：比较右美托咪定辅助硬膜外麻醉和丙泊酚-瑞芬太尼全身麻醉用于高龄美国麻醉医师协会（ ASA）分级Ⅲ级患者全髋骨置换术的临床效果。方法收集荆门市第一人民医院2012年2月至2013年7月收治的57例高龄（≥90岁） ASAⅢ级全髋骨置换术患者的临床麻醉资料，其中右美托咪定辅助硬膜外麻醉27例（ A组），丙泊酚-瑞芬太尼全身麻醉30例（ B 组）。比较两组患者围术期呼吸循环的稳定情况和术后麻醉恢复情况，术后24 h随访麻醉并发症发生情况及麻醉满意度情况。结果①A组患者手术期间生命体征无明显波动（P＞0.05）。 B组患者麻醉诱导前后及气管插管后血压和心率均出现显著波动（ P＜0.05）。 B组患者围术期心血管药物使用比例显著高于A组患者（ P＜0.01）。②A组患者18例术后直接回病房，9例在麻醉恢复室观察0.5～1 h；B 组13例术后控制呼吸直接回重症医学科病房，9例拔除气管导管，回重症医学科病房；8例在麻醉恢复室观察1～2 h。③B组患者术后认知功能障碍发生情况显著高于 A 组（P ＜0.05），同时麻醉满意度低于 A 组（P＜0.01）。结论适度剂量的右美托咪定辅助硬膜外麻醉是高龄 ASAⅢ级患者全髋骨置换术时一种有效和安全的麻醉方案。%Objective To compare the clinical effects between dexmedetomidine-assisted epidural anes-thesia and propofol-remifentanil general anesthesia in total hip replacement surgery for aged patients of Amer-ican Society of Anesthesiologists(ASA) Ⅲgrade.Methods The clinical anesthesia data of 57 aged patients (≥90 years) of ASA Ⅲ grade underwent total hip replacement surgeries in Jingmen First People′s Hospital from Feb.2012 to Jul.2013 were collected.Patients received dexmedetomidine-assisted epidural anesthesia included 27 cases( group A) and patients received propofol-remifentanil general anesthesia included 30 cases (group B),the perioperative stability of respiration and circulation,postoperative anesthetic recovery,as well as the incidences of anesthesia complications 24 h after the surgery and anesthesia satisfaction of the two groups were compared.Results ①There were no obvious fluctuation of vital signs during the operation in group A(P>0.05).There had were fluctuations of blood pressure and heart rate before and after anesthesia induction and tracheal intubation in group B ( P <0.05 ) .Proportion of perioperative cardiovascular drug application in Group B was significantly higher than that in group A ( P <0.01 ) .②In group A,18 cases directly returned to the ward after surgery,9 cases stayed in anesthesia recovery room for observation of 0.5-1 h;in group B,13 cases with postoperative controlled breathing directly returned to the intensive care unit , 9 cases returned to the intensive care unit after extubation,8 cases stayed in anesthesia recovery room for observation of 1-2 h.③The incidence of postoperative cognitive dysfunction in group B was significantly high-er than that in group A (P<0.05),while the degree of anesthesia satisfaction was extremely lower than that in group A(P<0.01).Conclusion For aged patients of ASA Ⅲ grade,moderate doses of dexmedetomi-dine-assisted epidural anesthesia is an effective and safe anesthesia in total hip replacement surgery .