摘要
目的评价老年患者股骨粗隆骨折手术应用腰丛阻滞和硬膜外阻滞的麻醉效果、血流动力学变化和肛门排气、膀胱功能恢复情况。方法行单侧股骨粗隆手术的老年患者60例，年龄65—97岁。随机分成腰丛组和硬膜外组（n=30）。分别采用患侧后路腰丛阻滞和腰1～2间隙的硬膜外阻滞。观察阻滞起效时间、麻醉效果、术中输液量、麻醉后1h的血压、心率变化和麻醉恢复情况。结果股神经、股外侧皮神经、隐神经和闭孔神经阻滞的起效时间腰丛组为（2．7±2．0）min、（3．1±3．4）min、（3．7±3．1）min和（3．5±3．3）min，硬膜外组为（13．5±2．1）min、（13．5±2．1）min、（13．5±2．1）min和（13．5±2．1）min，腰丛组均快于硬膜外组（均P〈0．01）；腰丛组的术后镇痛时间显著长于硬膜外组[（420±152）min vs（204±44）min]（P〈0．01）。硬膜外组阻滞后10～60min的血压均低于麻醉前（均P〈0．01）。腰丛组输液量显著少于硬膜外组[（773±353）ml vs （1483±444）ml]（P〈0．01），肛门排气时间显著短于硬膜外组（1．1±0．6h vs 5．9±1．2h）（P〈0．01），硬膜外组发生尿潴留需留置导尿患者显著多于腰丛组（8例vs 0例）（P〈0．01）。二组麻醉效果优良率均为100％，腰丛组优秀20例，良好10例；硬膜外组优秀28例，良好2例，硬膜外组优秀率显著高于腰丛组（P〈0．05）。结论老年患者股骨粗隆骨折手术可以选择腰丛阻滞或硬膜外麻醉，硬膜外阻滞麻醉效果优秀率更高，但腰丛阻滞术后消化系统、泌尿系统功能恢复更快。
Objective To compare the anesthesia efficacy, hemodynamics, recovery of passage of gas by anus and bladder function in elderly patients with operation of intertrochanteric femoral fracture with epidural or lumbar plexus block. Methods Sixty patients with intertrochanteric femoral fracture, aged 65- 97, were randomly divided into 3 equal groups ： lumbar plexus group （ Group A, undergoing posterior lumbar plexus block） and epidural group （ Group B, undergoing epidural block at L1-2 interspace）. The block onset time, anesthesia efficacy, transfusion amount during operation, blood pressure and heart rate change 1 h after anesthesia, and recovery after anesthesia were observed. Results The block onset time on femoral nerve, lateral cutaneous nerve of thigh, obturator nerve, and saphenous nerve of Group A were （2.7 ± 2.0） min, （3.1 ±3.4） min, （3.5 ±3.3） min, and （3.7 ±3.1 ） min respectively, all significantly shorter than those of Group B [（13.5±2.1） min, （13.5 ±2.1） min, （13.5 ±2.1） min, and （13.5±2.1） min respectively, all P 〈 0.01 ]. The duration of postoperative analgesia of Group A was （420 ± 152） min, significantly longer than that of Group B [ （ 204 ± 44） min, P 〈 0.05 ]. There were no significant differences in the change of blood pressure and heart rate between these 2 groups. The blood pressure decreased significantly 10 -60 min after anesthesia in Group B, and remained stable in Group A. The transfusion amount of Group A was （773 ±353） ml, significantly fewer than that in Group B [ （ 1483 ±444） ml, P 〈 0.01 ]. Passage of gas by anus started（ 1.1 ± 0.6）h after operation in Group A, a time significantly shorter than that in Group B （5.9 ±1.2） h, P 〈0.01 ）. Urinary retention was seen in 8 patients of Group B, however, no patient in Group A showed incidence of urinary retention （P 〈 0.01 ）. Forty-eight patients, 20 in Group A and 28 in Group B got excellent anesthesia effect, and 12 of them, 10 in Group A and 2 in Group B, got relatively good anesthesia （P 〈 0.05）. Conclusion Both lumbar plexus block and epidural block provide satisfactory anesthetic efficacy for operation of intertrochanteric femoral fracture in elderly patients. Epidural block provide better efficacy, and lumbar plexus block shows faster recovery of digestive system and urinary system after operation.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2008年第37期2614-2617,共4页
National Medical Journal of China
基金
浙江省科技厅资助项目（2005E33015）
关键词
麻醉
腰骶丛
麻醉
硬膜外
老年人
股骨粗隆手术
Anesthesia
Lumbosacral plexus
Anesthesia,epidural
Aged
Intertrochanteric femoral fracture surgery
