何加宁

[摘要] 目的 分析选择高龄患者髓部骨科手术最优的麻醉方式。 方法 将96例高龄髋部骨科手术患者随机分为A、B、C 三组，每组各32例。A组患者进行全身麻醉，B组患者使用腰硬联合麻醉，C组患者行硬膜外麻醉，对比三组患者不同麻醉方式的效果和并发症的情况。 结果 A 组麻醉效果最好，达到100.00%，B 组次之，C组麻醉效果只有68.75%；术中并发症发生率A组50.00%，B组21.88%，C组达到75.00%；术后肺部并发症A组达到12.50%，B、C两组都没有发生。数据分析差异有统计学意义（P<0. 05）。 结论 高龄患者髋部骨科手术的麻醉方法主要为全身麻醉或者腰硬联合麻醉，应根据患者的个体差异选择最佳的麻醉方式。

[关键词] 高龄患者；髓部骨科手术；麻醉方法

[中图分类号] R614 [文献标识码] B [文章编号] 2095-0616（2014）10-109-03

[Abstract] Objective To investigate the best anesthesia strategy of elderly patients with hip orthopedic surgery. Methods 96 cases of elderly hip orthopedic surgery were randomly divided into A，B，C three groups，each group 32 cases.Group A patients with general anesthesia，group B patients with lumbar epidural anesthesia， group C patients with epidural anesthesia，different anesthetic effects and complications of the situation were compared in the three groups of patients. Results Group A of anesthesia was preferably，up to 100.00%，next was group B，and group C was 68.75%；Complications during operation of group A was 50.00%，group B was 21.88%，and group C was 75.00%； Postoperative pulmonary complications of group A was 12.50%，group B and group C without complications.Data analysis was statistically significant different（P<0. 05）. Conclusion General anesthesia or epidural anesthesia is main methods for orthopedic surgery in elderly patients with hip joint anesthesia，and the best anesthesia should be chosen according to the patient's individual differences.

[Key words] Elderly patients；Hip orthopedics operation；Anesthesia methods

髋部骨科手术具有很大的创伤性和危险性[1]。高龄患者由于其身体机能的衰退和代谢缓慢以及恢复速率降低，在进行手术时会出现各种不适的情况，甚至出现危险的时刻，在术中和术后会出现不同程度的并发症[2]，所以，手术增加了不同程度的风险因素，对麻醉方式的选择也加大了难度。

1 资料与方法

1.1 一般资料

选取2012年12月～2013年12月我科接收的96例高龄髋部手术患者，年龄为60～93岁之间，男65例，女31例，随机分为A、B、C 三组，每组32例。其中有65例外伤性股骨颈骨折患者，31例股骨头无菌性坏死患者。52例术前合并原发性高血压患者；16例合并冠心病患者；28例合并糖尿病患者。3组患者在年龄、性别、术前情况中差异无统计学意义，具有可比性。

1.2 麻醉方法

患者手术前都应该做好术前准备和处理，主要是控制血压和血糖等。进入手术室还应该进行心电图测试，麻醉前应该打开静脉，滴注平衡液。……