轻比重腰麻联合硬膜外阻滞用于老年股骨颈骨折手术患者的麻醉体会

刘美玉曹芳①

(浙江省衢化医院麻醉科浙江衢州324004；①宁波大学医学院附属医院麻醉科)

[摘要]①目的评价轻比重腰麻联合硬膜外阻滞用于老年股骨颈骨折手术患者的麻醉效果。②方法随机选择美国麻醉医师协会(ASA)分级Ⅱ～Ⅲ级的老年股骨颈骨折手术患者102例，采用腰麻-硬膜外联合阻滞(CSEA)。患者侧卧，患肢在上，于L2-3或L3-4穿刺，腰麻给0.125%布比卡因5～7mL,1h后硬膜外给予1%利多卡因4mL试验量，如需要硬膜外再注入1.5%～2%利多卡因维持麻醉。观察腰麻后起效所需时间(注药至T10平面针刺无痛时间)、麻醉平面、麻醉效果、肌松度、麻醉前后平均动脉压(MBP)、心率(HR)、 脉搏氧饱和度(SpO2)、呼吸的变化等。③结果术中循环功能稳定，呼吸平稳，麻醉效果确切，肌松好。麻醉后MBP、HR、SpO2与术前比较差异无统计学意义(P>0.05)；术中均未用辅助药，无恶心、呕吐、头痛及神经系统并发症的发生，仅3例发生寒战。④结论实施轻比重腰麻主要阻滞患侧肢体，镇痛确切，术中血流动力学稳定，用于老年股骨颈骨折手术安全可靠。

[关键词]轻比重腰麻老年股骨颈骨折

[中图分类号]R 614.4[文献标识码]A

Application of hypobaric spinal anesthesia comblined epidurial block applied to elder femoral neck fractureLIUMeiyu,CAOFang(ZhejiangQuhuaHospital,Anesthesiologydepartment,QuzhouZhejiang324004,China)

ABSTRACT[]ObjectiveTo evaluate effect of hypobaric spinal anesthesia applied to elder femoral neck fracture.MethodsRandomly selected ASA classification level Ⅱ～Ⅲ 102 cases of patients with elder femoral neck fracture,Adopt the method of hypobaric spinal anesthesia comblined epidurial block(CSEA),On the side limb in,puncture from the L2～3 or L3～4,Use 0.125% Bupivacaine 5～7mL,epidural injection of 4ml of 1% lidocaine test after 60min utes.Again for epidural injection of 1.5%～2% lidocaine anesthesia if necessary.Observed the taking-effect time after anesthesia(time from injection to T10 flat acupuncture painless)anesthesia plane、anesthetic effect、muscle relaxant degrees、mean arterial blood pressure、heart rate、saturation of pulse oxygen、 respiratory changes、intraoperative auxiliary medicine usage、Presence of chills,nausea,vomiting postoperative headache,urinary retention,and neurological complications.ResultsIntraoperative circulation function stability,smooth breathing,anesthesia effect is exact,good muscle relaxant,MBP after anesthesia,HR,SpO2,there was no statistically significant difference compared with before operation(P>0.05);Intraoperative are not in the adjuvant,no nausea,vomiting,headache and neurological complications,only 3 cases of chills.Conclusion102 cases of elderly patients with femoral neck fracture implementation of main block of hypobaric spinal anesthesia,analgesic exactly,intraoperative hemodynamic stable,safe and reliable forelder femoral neck fracture.

[KEYWORDS]Hypobaric spinal anesthesia.Elder.Femoral neck fracture

随着我国进入老龄化社会，老年股骨颈骨折患者不断增多。但老年人常伴有心肺脑血管疾病、高血压及糖尿病等，心血管调节、代偿功能差，增加麻醉风险。为降低疼痛对患者产生的刺激，维持血流动力学稳定，麻醉平面应控制在最佳状态。本研究应用轻比重腰麻联合硬膜外阻滞用于老年股骨颈骨折患者手术1 987例，取得了良好的效果。现随……