摘要
目的:比较丙泊酚复合瑞芬太尼全身麻醉与腰-硬联合麻醉复合右美托咪定对高龄全髋置换患者应激及并发症的影响。方法:选择60例符合试验要求拟行全髋关节置换术患者,随机分为全身麻醉组(GA)和腰-硬联合麻醉复合右美托咪定组(CSEAD),比较两组麻醉前(T0)、全身麻醉插管与椎管内麻醉给药后即刻(T1)、手术开始30 min(T2)、手术结束时(T3)、拔除气管导管及硬膜外留置导管后(T4)的平均动脉压(MAP)和心率(HR)及血浆去甲肾上腺素(NE)及肾上腺素(E)浓度;观察记录两组手术时间、术中失血量和尿量、肺部感染、住院时间并发症、术后意识障碍及深静脉血栓形成。结果:GA组与本组T0时比较,在T1、T4时MAP明显升高,HR显著增快,差异有统计学意义(P<0.05);与CSEAD组比较,在T1、T4时MAP明显升高,HR显著增快,差异有统计学意义(P<0.05);与T0时比较,T1~T4时GA组血浆NE、E浓度显著升高,差异有统计学意义(P<0.05),且明显高于CSEAD组,差异有统计学意义(P<0.05)。CSEAD组各观察时点MAP、HR、NE和E均无明显变化,差异无统计学意义(P>0.05);GA组术后意识障碍及深静脉血栓形成发生率高。结论:两种麻醉方法均可以完成全髋关节置换术,但腰-硬联合麻醉复合右美托咪定应激反应较轻,并发症较少。
Objective To compare the stressive reactions and complications influence of propofol combined remifentanil anesthesia and epidural anesthesia combined dexmedetomidine in patients underwent total hip arthroplasty in elderly. Method 60 patients met the test requirements undergoing total hip replacement were selected and randomly divided into general anesthesia group（ GA） and lumbar epidural anesthesia group（ CSEAD）,comparing the concentration of plasma norepinephrine（ NE） and epinephrine（ E）,MAP and HR,at the time of before anesthesia（ T0）,anesthesia,intubation and vertebral the tube immediately after the administration of anesthesia（ T1）,surgery began 30 min（ T2）,at the end of surgery（ T3）,after extubation and epidural indwelling tubes（ T4）. Operative time,intraoperative blood loss and urine output,pulmonary infection,complications,length of hospital stay,postoperative consciousness and deep vein thrombosis of the two group were observed and recorded. Results In GA group,the T1,T4 was significantly higher in MAP with the group at T0,HR was significantly faster（ P〈0. 05）; and CSEAD group at T1,T4 was significantly higher in MAP,HR was significantly faster（ P〈0. 05）. When comparing with T0,T1- T4 when GA plasma NE,E concentrations were significantly increased（ P〈0. 05）,and significantly higher than CSEAD group（ P〈0. 05）. CSEAD group each observation point MAP,HR,NE and E did not change significantly（ P〉0. 05）; GA group after disturbance of consciousness and the high incidence of deep vein thrombosis. Conclusion Total hip arthroplasty can be managed by both anesthesia methods,but epidural anesthesia combined with dexmedetomidine has less stressive reaction and fewer complications
作者
顾珍梅
万云芳
张文元
GU Zhen-mei;WAN Yun-fang;ZHANG Fen-yuan(Department of Anesthesiology,Lianshui County Hospital of Traditional Chinese Medicine,Huaian 223400,China)
出处
《吉林医学》
CAS
2018年第7期1263-1265,共3页
Jilin Medical Journal
