[1]李亚南,张琦,霍树平,等.不同麻醉方式联合静脉快通道在老年下肢微创骨科手术中的应用研究[J].中华老年骨科与康复电子杂志,2017,(04):232-237.[doi:10.3877/cma.j.issn.2096-0263.2017.04.007]
　Li Yanan,Zhang Qi,Huo Shuping,et al.Comparison of different anesthesia methods combined with fast track anesthesia for elderly patients undergoing orthopedic minimally invasive lower limbs surgeries[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(04):232-237.[doi:10.3877/cma.j.issn.2096-0263.2017.04.007]
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不同麻醉方式联合静脉快通道在老年下肢微创骨科手术中的应用研究()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2017年04期
页码:
232-237
栏目:
出版日期:
2017-07-15

文章信息/Info

Title:
Comparison of different anesthesia methods combined with fast track anesthesia for elderly patients undergoing orthopedic minimally invasive lower limbs surgeries
作者:
李亚南 1; 张琦 1; 霍树平 1; 刘祥 2; 王秀丽 1; 王秋筠 1
050051 石家庄，河北医科大学第三医院麻醉科 1；050031 石家庄，河北省儿童医院麻醉科 2
Author(s):
Li Yanan1;  Zhang Qi1;  Huo Shuping1;  Liu Xiang2;  Wang Xiuli1;  Wang Qiujun1.
1Department of Anesthesiology, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China; 2Department of Anesthesiology, Children’s Hospital of Hebei Province, Shijiazhuang 050031, China
关键词:
麻醉;  微创外科手术;  骨科;  老年人
Keywords:
Anesthesia;  Minimal invasive surgical procedures;  Orthopedics;  Aged
DOI:
10.3877/cma.j.issn.2096-0263.2017.04.007
文献标志码:
A
摘要:
目的 比较不同麻醉方式联合静脉快通道麻醉在老年患者下肢微创骨科手术中的应用。方法 前瞻性收集 2016年 5月至 12月于河北医科大学第三医院行膝关节镜手术的患者 60例，其中男性 32例（53%），女性 28例（47%），年龄 65～85岁，BMI 21～29 kg/m2。采用随机数字表法分为 3组：手术部位局部浸润麻醉+静脉快通道麻醉组（LP组，n=20）、患侧髂筋膜间隙阻滞联合坐骨神经阻滞+静脉快通道麻醉组（NP组，n=20）及蛛网膜下腔阻滞+静脉快通道麻醉组（SP组，n=20）。三组患者于切皮前经静脉注射丙泊酚0.5～1 mg/kg，继而持续泵注0.06～0.1 mg/kg/min的丙泊酚至术毕，维持术中脑电双频指数（BIS）值50～60。记录并比较各组患者单次操作成功率、术中血压、心率、血氧饱和度、BIS值、丙泊酚用量、镇痛药和血管活性药物应用情况、辅助通气情况、苏醒时间、术后并发症发生率及住院时间。结果三组患者术中均未发生不良事件。与LP组比较，NP组和SP组术中辅助呼吸应用率（c2=4.263，P＜0.05）、镇痛药物应用率（c2=3.392，P＜0.05）、丙泊酚用量（q=4.983，q=5.284，P＜0.05）及术后苏醒时间（q=3.408， q=54.172，P＜0.05）均较少，T1 时间点 HR 和 BP 较低（q=3.534，q=3.639，q=3.658，q=3.722，P＜0.05）， SpO2和BIS值较高（q=3.968，q=4.113，q=5.337，q=5.472，P＜0.05）。与 SP组比较，LP组和 NP组术后恶心呕吐（c2=5.082，P＜0.05）及尿潴留发生率（c2=6.173，P＜0.05）较低，一次操作成功率较高（c2=3.893， P＜0.05）。结论 局部浸润麻醉、神经阻滞及蛛网膜下腔阻滞麻醉方式联合静脉快通道麻醉均可安全应用于老年微创下肢骨科手术，但神经阻滞联合静脉快通道麻醉效果较好，术后并发症少，更适用于老年下肢微创骨科手术的患者。
Abstract:
Objective To compare different anesthesia methods combined with fast track anesthesia in orthopedic minimally invasive lower limbs surgeries in the elderly. Methods A prospective study was performed in 60 cases who underwent arthroscopic knee surgery in the Third Hospital of Hebei Medical University from May 2016 to December 2016. There were 32 males and 28 females, the range of age and body mass index were 65 to 85 years, and 21 to 29 kg/m2. All patients were randomly divided into 3 groups using a random number table: Local anesthesia combined with fast track anesthesia group (group LP, n=20), nerve block combined with fast track anesthesia group (group NP, n=20) and spinal anesthesia combined with fast track anesthesia group (group NP, n=20). LP group received local infiltration anesthesia on surgical site; NP group received iliac fascia clearance block combined with sciatic nerve block; SP group were spinal anesthesia. Before incision, they were used 0.5-1 mg/kg propofol via intravenous with infusion rate of 0.06- 0.1mg/kg/min and maintained the bispectral index value between 50-60. BP, HR, SpO2, BIS, applications of analgesics, operation success rate, vascular active drugs and assisted ventilation, awakening time, dosage of propofol, postoperative complications and length of hospital stay were recorded. Results No adverse events occurred during operation. Compared to LP group, intraoperative auxiliary respiratory rate (c2=4.263, P<0.05), analgesia drug utility ratio (c2=3.392, P<0.05), dosage of propofol （q=4.983, q=5.284, P<0.05）of NP and SP group were significantly decreased, same as the awakening time (q=3.408, q=54.172, P<0.05), heart rates and blood pressure (q=3.534, q=3.639, q=3.658, q=3.722, P<0.05) at T1, while SpO2 and BIS at T1were increased (q=3.968, q=4.113, q=5.337, q=5.472, P<0.05); Compared to SP group, incidence of nausea and vomiting (c2=5.082, P<0.05) and incidence of urinary retention (c2=6.173, P<0.05) was significantly lower in LP and NP group while operation success rate (c2=3.893, P<0.05) were increased. Conclusions Different anesthesia methods combined with fast track anesthesia can be safely used in orthopedic minimally invasive lower limbs surgeries in the elderly. Nerve block combined with fast track anesthesia had better anesthetic effect and fewer postoperative complications, which is more suitable for orthopedic minimally invasive lower limbs surgeries in the elderly.

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备注/Memo

备注/Memo:
国家自然科学基金（30972832）；河北省政府资助临床优秀人才培养和基础课题研究项目（361005）
更新日期/Last Update: 2017-07-14