腰硬联合麻醉在老年髋关节置换手术中应用.docVIP

腰硬联合麻醉在老年髋关节置换手术中应用 　　doi：10.3969/j.issn.1007-614x.2014.15.40 　　摘 要 目的：比较腰硬联合麻醉（CSEA）与全麻（GA）对老年髋关节置换手术术后认知功能障碍（POCD）的影响。方法：选择老年髋关节置换手术患者30例，年龄61～84岁，ASA 1～2级，随机分为两组，CSEA组与GA组，每组15例。CSEA组使用腰硬联合穿刺包，用腰硬联合麻醉，GA组用静脉复合或静吸复合麻醉，观察术中输液输血及出血量和麻醉效果，术后随访发生POCD的病例。结果：两组患者术中输液输血及出血量差异无统计学意义，麻醉效果差异有统计学意义（P0.05），POCD发生差异有统计学意义（P0.05）。结论：腰硬联合麻醉对于老人髋关节置换手术是一种安全而有效的麻醉方法，能明显降低POCD发生。 　　关键词 腰硬联合麻醉 老年 术后认知功能障碍 　　Application of combined spinal and epidural anesthesia in elderly hip replacement surgery 　　Fu Zhiquan，Zhao Guang，Song，Yunqiang 　　Guizhou Spaceflight Hospital 563003 　　Abstract Objective：To compare the effect of postoperative cognitive dysfunction（POCD） of combined spinal and epidural anesthesia （CSEA） and general anesthesia（GA） in elderly hip replacement surgery.Methods：30 patients with elderly hip replacement surgery were selected.The age was 61 to 84 years old.ASA was 1 to 2 class.They were randomly divided into CSEA group and GA group with 15 cases in each.CSEA group used waist hard joint puncture bag，used combined spinal and epidural anesthesia.GA group used combined intravenous or inhalation anesthesia.Transfusion，the amount of bleeding and anesthetic effect during operation were observed.The POCD cases occured in postoperative follow up.Results：In the two groups，the transfusion and amount of bleeding had no obvious difference.The anesthetic effect had obvious difference（P0.05）.The incidence of POCD had obvious difference（P0.05）.Conclusion：Combined spinal and epidural anesthesia in elderly hip replacement surgery is a safe and effective anesthesia method.It can significantly reduce the incidence of POCD. 　　Key words Combined spinal and epidural anesthesia；Elderly；Postoperative cognitive dysfunction 　　随着人们对POCD认识的提高，神经阻滞在老年人麻醉中的作用逐渐被重新认识。现将腰硬联合麻醉应用于老年髋关节置换手术中，取得满意的效果，能明显降低POCD发生，术毕清醒能配合治疗，减少并发症的发生，降低住院时间和医疗费用。 　　资料与方法 　　老年髋关节置换手术患者30例，男18例，女12例，年龄61～84岁。全组无麻醉手术禁忌证及精神病史，ASA 1～2级，随机分为两组：CSEA组和GA组，每组15例。两组患者身高、年龄、体重等一般情况方面均无统计学意义。 　　麻醉方法：两组患者于麻醉前均不用术前药，患者入室后，静注长托宁0