王言武

[摘要] 目的 研究分析老年下肢骨折手术患者采用不同的麻醉方式对患者循环功能的影响。方法 回顾分析该院2011年3月—2013年3月收治的下肢骨折手术患者160例，分为全麻组与腰硬联合麻醉组，分别采用全麻与腰硬联合麻醉方式进行麻醉.分别在麻醉前T0、麻醉后T1、手术进行5 minT2、15 minT3、30 minT4、60 minT5进行比较患者MAP、HR、RR、SPO2指标的变化。结果 全麻醉MAP变化为108.5±8.3，87.1±7.3，联合组108.3±8.1，104.6±7.3，两组之间比较全麻醉变化明显多于联合组，其差异有统计学意义（P<0.05）， 全麻组HR变化为85.7±9.3，66.3±7.3，联合组87.8±8.1，73.6±7.2，全麻组变化明显多于腰硬联合麻醉组，其差异有统计学意义（P<0.05），两组患者SPO2与RR变化差异无统计学意义（P>0.05）。结论 腰硬联合麻醉在老年下肢骨折手术中各项指标变化相对较少，麻醉效果好，且对患者循环功能影响较小，更适合在老年下肢骨折手术中使用，安全性更高。

[关键词] 麻醉；下肢骨折手术；循环功能

[中图分类号] R614 [文献标识码] A [文章编号] 1674-0742（2014）05（c）-0008-03

[Abstract] Objective To study and analyze the impacts of different anesthesia methods on the circulatory function of elderly patients during lower limb fracture surgery. Methods 160 patients with lower limb fracture admitted in our hospital from March， 2011 to March， 2013 were retrospectively analyzed. They were divided into general anesthesia group and CSEA group and given general anesthesia， CSEA， separately. MAP， HR， RR and SPO2 at T0 （before anesthesia）， T1 （after anesthesia）， T2 （operation was performed for 5 min）， T3 （operation was performed for 15 min）， T4 （operation was performed for 30 min） and T5 （operation was performed for 60 min） of the 2 groups were compared. Results In general anesthesia group， the change of MAP was 108.5±8.3， 87.1±7.3 and in CSEA group was 108.3±8.1， 104.6±7.3， the change in the former was more than that in the latter， the difference was statistically significant （P<0.05）. In general anesthesia group， the change of HR was 85.7±9.3， 66.3±7.3 and in CSEA group was 87.8±8.1， 73.6±7.2， the changes in the former were much more than those in the latter， the difference was statistically significant （P<0.05）. The differences in SPO2 and RR between the 2 groups were not statistically significant （P>0.05）. Conclusion CSEA for lower limb fracture surgery of elderly patients has little change in each index during the operation； it has good anesthetic effect with little impact on the circulatory function of patients， so it's more suitable to be applied in lower limb fracture surgery of elderly patients with higher safety.

[Key words] Anesthesia； Lower limb fracture surgery； Circulatory function

老年人进行手术治疗时分风险高于其他年龄段，老年人的生理机能减退，并且常常合并循环系统、呼吸系统疾病，所以会增加手术的风险[1-2]。老年人骨折疏松，是骨折高发年龄段，治疗上常常采用手术治疗，且手术难度大，时间长，所以对于老年人行下肢骨折手术需要采用麻醉效果好，安全性更高，对循环影响更小的麻醉方式。临床常常采用全麻和腰硬联合麻醉，为研究比较两种麻醉方式对老年下肢骨折手术循环功能的影响，现分析2011年3月—2013年3月间该院收治的下股骨折手术患者160例的临床资料，报道如下。

1 资料与方法

1.1 一般资料endprint

选取该院收治的下肢骨折手术患者160例，全麻组80例，腰硬联合麻醉80例，全麻组男46例，女34例，年龄62～78岁，平均年龄（70.3±5.2）岁，行全髋置换术25例，股骨头置换术23例，股骨内固定术20例，胫骨内固定术12例；……