Objective To compare the effects of lumbar plexus with sciatic nerve block and combined spinal epidural anesthesia on femoral head replacement in elderly patients.Methods Seventy-nine cases in our hospital from January 2014 to December 2015 of femoral head replacement surgery in elderly patients were analyzed retro-spectively.According to the different ways of anesthesia,they were divided into Group A with lumbar plexus combined sciatic nerve block anesthesia(28 cases),and Group B with combined spinal epidural anesthesia (51 ca-ses).The vital signs of the two groups were observed and recorded before and after anesthesia,including systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),and other vital signs and complications. The amount of transfusion and complications or adverse reactions in the two groups were recorded,and the analge-sic effect was compared.Results The vital signs of two groups of patients after anesthesia were lower than those before anesthesia,the difference was statistically significant (P <0.05).There was no significant difference in the changes of vital signs after anesthesia in Group A compared with those in Group B (P >0.05 ).The amount of transfusion in Group B was significantly higher than that in Group A,the difference was statistically significant (P<0.05).In Group A,there was one patient with headache after operation,and postoperative nausea and vomiting occurred in 3 patients in Group B.There was no significant difference in adverse reactions between the two groups (P >0.05).After anesthesia,the analgesic effect of Group B was significantly better than that of Group A,the difference was statistically significant (P < 0.05 ).Conclusion Both lumbar plexus with sciatic nerve block and combined spinal epidural anesthesia for elderly patients with femoral head replacement have good curative effect. The anesthesia effect of lumbar plexus with sciatic nerve block is good,which can effectively reduce the risk of im-mune suppression and urinary tract infections.By the way,it may need add more sedative or analgesic drugs.The analgesic effect of combined spinal epidural anesthesia is obvious,but the volume of transfusion was larger in the operation.According to the actual condition of the patient,physical quality and tolerance,the clinician can choose the appropriate anesthesia method for patients to reduce the pain,to better improve the quality of medical care.%目的 比较腰丛-坐骨神经阻滞和腰硬联合麻醉对老年患者股骨头置换术手术情况的影响.方法 回顾性分析2014年1月至2015年12月入我院行股骨头置换术的老年患者79例,按照手术麻醉方式不同分为A组采用腰丛-坐骨神经阻滞麻醉患者28例,B组采用腰硬联合麻醉患者51例.观察并记录2组患者麻醉前、麻醉后收缩压(SBP)、舒张压(DBP)和心率(HR)等生命体征,记录2组患者术中输液总量及并发症或不良反应发生情况,比较患者麻醉后镇痛效果.结果 2组患者麻醉后各项生命体征较麻醉前均有所降低,差异有统计学意义(P<0.05);A组患者麻醉后各项生命体征变化较B组同期差异无统计学意义(P>0.05).B组患者术中输液总量明显高于A组,差异有统计学意义(P<0.05).2组患者围术期均无并发症发生,A组1例患者术后出现头痛,B组3例患者术后出现恶心、呕吐,2组患者不良反应比较,差异无统计学意义(P>0.05).麻醉后,B组镇痛效果明显优于A组,差异有统计学意义(P<0.05).结论 腰丛-坐骨神经阻滞和腰硬联合麻醉对老年患者股骨头置换术均有较好的疗效.腰丛-坐骨神经阻滞麻醉效果好,能有效降低免疫抑制及尿路感染风险,但可能需要加用更多的镇静或镇痛类药物;腰硬联合麻醉对患者镇痛效果明显,但术中输液量较大.临床医生可根据患者实际病情、身体质量及可否耐受等选择合适的麻醉方式,为患者减轻病痛,更好地提高医疗质量.
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