上官明化 罗来凤

[摘要] 目的 探討80岁以上高龄患者行下肢骨科手术应用外周神经阻滞联合静脉快通道麻醉的效果。 方法 方便选取2016年7月—2017年12月期间在该院行下肢骨科手术且年龄在80岁以上的患者92例，按照麻醉方法不同，分为对照组（n=46）和观察组（n=46），对照组实施气管插管静脉麻醉，观察组应用外周神经阻滞联合静脉快通道麻醉，观察两组患者血流动力学情况，记录患者的拔管时间、呼吸恢复时间以及彻底清醒时间，并于术前、术后3 d、术后7 d对两组患者的认知功能进行统计。 结果 观察组患者的拔管时间、呼吸恢复时间以及彻底清醒时间明显低于对照组[分别为（8.57±3.39）min vs （21.45±3.34）min，t=18.36 ，P<0.05；（8.12±2.05）min vs （19.17±2.34）min，t=24.09，P<0.05；（15.47±2.56）min vs （28.26±2.37）min， t= 24.87，P<0.05]；观察组患者血流动力学情况优于对照组[心率：（82.12±6.05）次/min vs （89.17±6.34）次/min， t=5.46 ，P<0.05；舒张压：（81.47±12.39）mmHg vs （115.45±11.34）mmHg， t=13.72，P<0.05；收缩压： （131.47±15.56）mmHg vs （165.26±15.37）mmHg， t=10.48 ，P<0.05]；术后3 d和7 d，观察组的认知功能评分都明显高于对照组[术后3 d：（25.57±2.39）分 vs （21.45±2.34）分， t=8.35 ，P<0.05；术后7 d：（26.07±2.06）分 vs （24.26±1.37）分， t=4.96 ，P<0.05]；两个组别患者不良反应发生情况差异无统计学意义（P>0.05）。 结论80岁以上高龄患者下肢行骨科手术时应用外周神经阻滞联合静脉快通道麻醉，能够保持患者的血流动力学稳定，减小对心血管的影响和认知功能的影响，值得推广。

[关键词] 下肢骨科手术；外周神经阻滞联合静脉快通道麻醉；高龄患者

[中图分类号] R614 [文献标识码] A [文章编号] 1674-0742（2018）08（a）-0043-04

An Analysis of the Effect of Peripheral Nerve Block Combined with Venous Fast Channel Anesthesia in Older 80-year-old Orthopedic Surgery

SHANGGUAN Ming-hua， LUO Lai-feng

Department of Anesthesiology， Fifth Clinical College， Fujian University of Traditional Chinese Medicine， Sanming Second Hospital， Yong'an， Fujian Province， 366000 China

[Abstract] Objective To investigate the effect of lower limb orthopedic surgery on elderly patients over 80 years of age using peripheral nerve block combined with venous fast channel anesthesia. Methods From July 2016 to December 2017， 92 patients with orthopedic surgery in the lower limbs of the hospital aged 80 and over were convenient divided into control group（n=46） and observation group （n=46） according to different anesthetic methods. The control group was subjected to tracheal intubation and intravenous anesthesia. The observation group was treated with peripheral nerve block combined with venous fast channel anesthesia. The hemodynamics of the two groups were observed. The patient's extubation time， respiratory recovery time， and complete awake time were recorded， and preoperative， postoperative 3 days， 7 days postoperatively， the cognitive function of the two groups of patients were counted. Results The time of extubation， respiration recovery， and total awake time were significantly lower in the observation group than in the control group [（8.57±3.39）min vs （21.45±3.34）min， t=18.36， P<0.05； （8.12±2.05）min vs （19.17±2.34）min，t=24.09， P<0.05； （15.47±2.56）min vs （28.26±2.37）min， t=24.87， P<0.05]； Hemodynamics of the observation group were better than that of the control group [heart rate： （82.12±6.05）times/min vs （89.17±6.34）times/min， t=5.46， P<0.05； diastolic blood pressure： （81.47±12.39）mmHg vs （115.45±11.34）mmHg， t=13.72， P<0.05； systolic blood pressure： （131.47±15.56）mmHg vs （165.26±15.37）mmHg， t=10.48， P<0.05]； The cognitive function scores of the observation group were significantly higher than those of the control group on the 3rd and 7th days after operation [3 days after operation： （25.57±2.39）points vs （21.75±2.34）points，t=8.35， P<0.05； 7 days postoperatively： （26.07±2.06）points vs （24.26±1.37）pointst=4.96， P<0.05]； there was no significant difference in adverse reactions between the two groups （P>0.05）. Conclusion The use of peripheral nerve block combined with venous fast channel anesthesia in the lower limbs of elderly patients over 80 years of age can maintain the hemodynamic stability， reduce the impact on cardiovascular and cognitive function， and is worthy of promotion.

[Key words] Lower limb orthopedic surgery； Peripheral nerve block combined with venous fast channel anesthesia； Elderly patients

下肢骨折属于骨科常见病，患者以老年人居多[1]，临床上多采用手术的方式对其进行治疗。随着人口老龄化，我国80岁以上的老人越来越多，器官储备功能下降、机体免疫能力减弱及对手术的疼痛反应明显是这一部分人群的显著特征[2]，同时老年患者对麻醉打击的应激反应强烈，容易造成术后认知障碍[3]，因而手术前合理的麻醉尤为重要。该文主要研究2016年7月—2017年12月期间外周神经阻滞联合静脉快通道麻醉对80岁以上老人行下肢骨科手术的效果，现报道如下。……