腰麻用于老年患者全髋置换术的临床观察
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摘要
目的观察腰麻用于60岁以上老年患者全髋置换术的安全性和临床疗效。方法 60岁以上股骨头坏死的患者60例,ASAⅡ~Ⅲ级,采用蛛网膜下腔阻滞。观察入室时生命体征(T0)和注药后5 min(T1)、10 min(T2)、15 min(T3)、30 min(T4)和手术结束时(T5)的血压及心率的变化和麻醉效果。结果 60例患者布比卡因的用量(6.5±0.5)mg;手术时间(51.5±10.00)min,T1~T4时BP明显低于T0时,T1时HR明显快于T0时(P<0.01或P<0.05)。所有患者的麻醉感觉阻滞平面控制在T10~T12,注药后两组患者胸闷及恶心呕吐等不良反应,比较差异无统计学意义(P>0.05)。麻醉效果优58例,良2例。结论蛛网膜下腔阻滞麻醉用于60岁以上老年患者的全髋置换术是安全有效的。
Objective To observe the safety and clinical efficacy of spinal anesthesia for total hip replacement in elderly patients over 60 years old. Methods 60 patients with avascular necrosis of the femoral head over 60 years of age were treated with subarachnoid block(ASA II/III). The vital signs(T0), 5 min(T1), 10 min(T2), 15 min(T3), 30 min(T4), and blood pressure and heart rate at the end of operation(T5) were observed and the effect of anesthesia was observed. Results The dosage of bupivacaine in 60 patients(6.5 ± 0.5) mg; operation time(51.5 ± 10.00) min; T1~T4 was significantly lower than T0 at BP; HR was significantly faster than T0 at T1(P< 0.01 or P< 0.05). The anesthesia sensation block planes of all patients were controlled by T10~T12, and there was no significant difference between the two groups in their chest tightness, nausea and vomiting(P>0.05). The results of anesthesia were excellent in 58 cases and good in 2 cases. Conclusion Subarachnoid block anesthesia is safe and effective for total hip replacement in elderly patients over 60 years of age.
Objective To observe the safety and clinical efficacy of spinal anesthesia for total hip replacement in elderly patients over 60 years old. Methods 60 patients with avascular necrosis of the femoral head over 60 years of age were treated with subarachnoid block(ASA II/III). The vital signs(T0), 5 min(T1), 10 min(T2), 15 min(T3), 30 min(T4), and blood pressure and heart rate at the end of operation(T5) were observed and the effect of anesthesia was observed. Results The dosage of bupivacaine in 60 patients(6.5 ± 0.5) mg; operation time(51.5 ± 10.00) min; T1~T4 was significantly lower than T0 at BP; HR was significantly faster than T0 at T1(P< 0.01 or P< 0.05). The anesthesia sensation block planes of all patients were controlled by T10~T12, and there was no significant difference between the two groups in their chest tightness, nausea and vomiting(P>0.05). The results of anesthesia were excellent in 58 cases and good in 2 cases. Conclusion Subarachnoid block anesthesia is safe and effective for total hip replacement in elderly patients over 60 years of age.
引文
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[10]汪伟,郁万友,钱燕宁.芬太尼复合小剂量布比卡因腰麻在老年患者下肢手术中的应用[J].临床麻醉学杂志,2013,29(11):1088-1099.
[2]邓小明,姚尚龙,于布为,等.现代麻醉学[M].版.北京:人民卫生出版社,2014:1153.
[3]杨雪梅.静脉给予右美托咪定对罗哌卡因蛛网膜下腔阻滞效果的影响.中国继续医学教育,2016,8(5):63-65.
[4]赫丽华,王新,张弓.笔尖式25G针单次蛛网膜下腔阻滞用于90例经尿道前列腺电切术患者麻醉的体会[J].实用医技杂志,2015,22(6):634-635.
[5]秦海天.蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉用于下腔静脉曲张手术[J].上海医学.201-206.
[6]孙波.单侧蛛网膜下腔阻滞在下肢手术的麻醉效果观察.中国伤残医学[J],2013,21(11):125-126.
[7]邓小明,曾因明译.米勒麻醉学[M].第七版.北京:北京大学出版社,2011.
[8]朱学智,周涛,武永强.预防性静脉注射麻黄碱对剖宫产术蛛网膜下腔阻滞后低血压的影响[J].山西医药杂志,2012,41(9):594-595.
[9]杭南燕,实用麻醉手册[M].上海:上海世界图书出版社,2011.
[10]汪伟,郁万友,钱燕宁.芬太尼复合小剂量布比卡因腰麻在老年患者下肢手术中的应用[J].临床麻醉学杂志,2013,29(11):1088-1099.