摘要
目的探讨全身麻醉及其联合腰硬联合麻醉对老年骨折患者麻醉效果以及对血流动力学及呼吸循环系统的影响。方法选取2016年5月-2017年5月本院收治的下肢骨折老年患者100例为研究对象,根据随机数字表法分为观察组(n=50)和对照组(n=50)。对照组患者采用全身麻醉,观察组患者行全身麻醉和腰硬联合麻醉。比较两组麻醉情况,麻醉前(T0)、麻醉后5 min(T1)、术后5 min(T2)、术后15 min(T3)、术后30 min(T4)、术后60 min(T5)时心指数(CI)、每搏量变异度(SVV)、呼吸(R)和血氧饱和度(SPO2)变化,及两组不良反应发生率。结果观察组麻醉起效时间、阻滞完全时间和苏醒时间分别为(53.48±12.38)s、(12.93±3.05)min和(16.39±6.24)min,显著短于对照组(P<0.05);两组CI在各时间点与T0比较,均显著降低(P<0.05),观察组在T2、T3、T4时间点CI显著高于对照组(P<0.05),两组SVV在T1、T3、T4时间点比较,差异有统计学意义(P<0.05),两组R和SPO2在各时间点比较,差异均无统计学意义(P>0.05);观察组总不良反应发生率为10.00%,对照组总不良反应发生率为34.00%,差异有统计学意义(P<0.05)。结论对于老年骨折患者而言,全身麻醉与腰硬联合麻醉结合使用可提高麻醉效果,并减少对患者血流动力学影响,安全性更高。
Objective To investigate the effects of general anesthesia and that combined with spinal epidural anesthesia on hemodynamics and on the respiratory and circulatory system in elderly patients with fracture. Methods The 100 cases of elderly patients with lower limb fracture admitted to our hospital between May 2016 and May 2017 were selected for this study and divided into the observation group（ n = 50） and the control group（ n = 50） using the random number table method. The patients in the control group were treated with general anesthesia while those in the observation group were additionally given spinal epidural anesthesia. The anesthesia conditions,the cardiac index（ CI）,stroke volume variation（ SVV）,respiratory（ R） and oxygen saturation（ SPO2） changes and adverse reactions before anesthesia（ T0）,5 min after anesthesia（ T1）,5 min after operation（ T2）,15 min after operation（ T3）,30 min after operation（ T4）,60 min after operation（ T5） were compared between the two groups.Results The onset time,blocking time and recovery time of the observation group were（ 53.48± 12.38） s,（ 12.93± 3.05） min and（ 16.39±6.24） min respectively,which were significantly shorter than those of the control group（ P〈0.05）. The CI at each time point was significantly decreased in both groups compared with T0（ P〈0.05）,and the CI at T2,T3 and T4 in the observation group was significantly higher than that in the control group（ P〈0.05）. The difference of SVV at T1,T3 and T4 was statistically significant between the two groups（ P〈0.05）,but the difference of R and PO_2 at each time point was not（ P〈0.05）. The total adverse reaction rate was 10.00% in the observation group and 34.00% in the control group,so the difference was statistically significant（ P〈0.05）.Conclusion For elderly patients with fracture,the combined use of general anesthesia and spinal epidural anesthesia can improve the anesthetic effect and reduce the hemodynamic impact on the patients with better safety.
作者
舒平
SHU Ping(Department of Anesthesiology,the Second People＇s Hospital of Jiangyou,Jiangyou Siehuan 621700,China)
出处
《解放军预防医学杂志》
CAS
2018年第7期870-872,932,共4页
Journal of Preventive Medicine of Chinese People's Liberation Army
基金
四川省医学会中青年扶持计划(No.20130718)
关键词
全身麻醉
腰硬联合麻醉
老年骨折
血流动力学
呼吸循环系统
general anesthesia
combined spinal epidural anesthesia
senile fracture
hemodynamics
respiratory and circulatory system
