腰麻―硬膜外麻醉在超高龄患者骨折手术中价值分析.docVIP

腰麻―硬膜外麻醉在超高龄患者骨折手术中价值分析 　　[摘要] 目的 探讨腰麻-硬膜外麻醉在超高龄患者骨折手术中的应用效果。方法 随机抽取该院2013年5月―2014年5月骨科收治的72例超高龄骨折患者的临床资料。患者随机分为实验组和对照组，每组36例。实验组患者采取腰麻-硬膜外麻醉，对照组患者采取持续硬膜外麻醉。比较两组患者麻醉前、麻醉后、5 min、10 min、30 min、60 min时HR、SBP、DBP、SpO2水平变化情况、是否出现呼吸抑制或头痛难忍等不良反应以及VAS评分情况。结果 所有患者麻醉后5 min HR显著升高、SBP显著下降，与麻醉前比较，差异具有统计学意义（P0.05）；无1例患者出现头痛难忍或呼吸抑制等不良反应，VAS评分均不超过4分。实验组患者平均麻醉起效时间、阻滞完善时间、硬膜外用药量均优于对照组，差异有统计学意义（P0.05）。结论 腰麻-硬膜外麻醉对超高龄患者骨折手术中血流动力学各项指标影响较小，患者耐受性好，临床应用安全性较高。 　　[关键词] 腰麻-硬膜外麻醉；超高龄骨折；手术 　　[中图分类号] R614 [文献标识码] A [文章编号] 1674-0742（2015）09（c）-0011-03 　　[Abstract] Objective To explore the effect of combined spinal-epidural analgesia applied to over-aged patients with fracture. Methods The clinical data of 72 over-aged cases with fracture admitted in the Department of Orthopedics of our hospital from May 2013 to May 2014 were selected. The patients were randomly divided into the experimental group and the control group with 36 cases in each. Patients in the experimental group were treated by combined spinal-epidural analgesia， and those in the control group were treated by continuous epidural anesthesia. The changes in HR， SBP， DBP and SpO2 before anesthesia and 5min， 10min， 30min， 60min after anesthesia， incidence of respiratory depression or severe headache beyond suffering and other adverse reactions， and VAS were compared between the two groups. Results Compared with before anesthesia， HR increased while SBP decreased significantly in all the patients 5min after anesthesia （P0.05）. No patients had severe headache beyond suffering or respiratory depression. And all the patients had VAS no more than 4 points. Compared with the control group， the experimental group had much earlier mean anesthetic onset time， shorter mean time for perfectly blocking， less mean epidural dosage with statistically significant differences（P0.05）. Conclusion For over-aged patients with fracture， combined spinal-epidural analgesia has small effect on the indexes of haemodynamics with good tolerance and high safet