文章摘要
三种常见麻醉方式对全髋关节置换术的老年患者术后转归的影响
Three different anesthesia techniques for total hip arthroplasty in elderly patients on the postoperative quality of recovery
  
DOI：10.12089/jca.2018.07.011
中文关键词: 老年患者  全髋关节置换  术后转归
英文关键词: Elderly patients  Total hip arthroplasty  Quality of recovery
基金项目:
作者单位E-mail
高翔 238000,巢湖市,安徽医科大学附属巢湖医院麻醉科  
夏晓琼 238000,巢湖市,安徽医科大学附属巢湖医院麻醉科 xxq2366833@sina.com 
王亮 238000,巢湖市,安徽医科大学附属巢湖医院麻醉科  
夏书江 238000,巢湖市,安徽医科大学附属巢湖医院麻醉科  
査显忠 238000,巢湖市,安徽医科大学附属巢湖医院麻醉科  
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中文摘要:
      
目的 比较三种常见麻醉方式对全髋关节置换术的老年患者术后转归的影响。

方法 择期行单次全髋关节置换术的老年患者150 例,男84例,女66例,年龄67～92岁,BMI 19.6～23.4 kg/m2,ASA Ⅱ或 Ⅲ 级。随机分为三组: 全身麻醉组(GA组),腰麻-连续硬膜外麻醉组(CSEA组),腰丛-坐骨神经阻滞组(PCSNB组),每组50例。GA组常规麻醉诱导: 咪达唑仑0.05 mg/kg、丙泊酚1～2 mg/kg、舒芬太尼0.4～0.6 μg/kg、罗库溴铵0.8～1.0 mg/kg。插管后,持续静注丙泊酚6～8 mg·kg-1·h-1。CSEA组在L2-3间隙穿刺,蛛网膜下腔注入1%罗哌卡因1.5 ml+10%葡萄糖注射液0.2 ml,硬膜外置管。PCSNB组在超声引导下于腰丛位置L3-4间隙注射0.375%罗哌卡因25 ml,坐骨神经周围注射0.375%罗哌卡因20 ml。记录三组患者麻醉操作时间,术中出血量,术中补液量,手术时间。记录术后24 h 静脉自控镇痛（PCA）用药量,下床活动时间、术后住院时间。记录肺栓塞、肺炎、肾衰竭、心肌梗死、脑卒中、机械通气、术后7 d POCD等术后并发症情况。

结果 与GA组比较,CSEA组和PCSNB组麻醉操作时间明显延长(P<0.05),术中出血量明显减少(P<0.05),手术时间明显缩短(P<0.05),术后24 h PCA用药量明显减少(P<0.05),下床活动时间和术后住院时间均明显缩短(P<0.05),术后肺炎和术后7 d POCD发生率明显降低(P<0.05)。CSEA组与PCSNB组各指标差异均无统计学意义。三组术后肾衰竭、心肌梗死、脑卒中和机械通气发生率差异无统计学意义。

结论 本研究为老年患者全髋关节置换术麻醉方式的比较。腰麻-连续硬膜外麻醉和腰丛-坐骨神经联合神经阻滞麻醉应用全髋关节置换术老年患者,可减少术中出血量,缩短手术时间,镇痛效果好,术后并发症发生率低,术后恢复快。虽然CSEA与PCSNB之间并无差异,PCSNB对于有椎管内麻醉禁忌证的患者更为适用。
英文摘要:
      
Objective To compared the three anesthetic techniques on the postoperative quality of recovery in elderly patients after total hip arthroplasty.

Methods A total of 150 patients, including 84 males, 66 females, aged 67-92 years, BMI 19.6-23.4 kg/m2, ASA physical status Ⅱ or Ⅲ, preparing to undergo THA into 3 groups(n=50 each): general anesthesia group (group GA), combined spinal-epidural anesthesia group (group CSEA), ultrasound-guided combined psoas compartment-sciatic nerve block group (group PCSNB). In group GA, anesthesia was induced with midazolam 0.05mg/kg, sufentanil 0.4-0.6 μg/kg and rocuronium 0.8-1.0 mg/kg. After endotracheal intubation, the infusions was maintained by continuous infusion of propofol 6-8 mg·kg-1·h-1. In group CSEA, the puncture of combined spinal-epidural anesthesia in group was performed in the L2-3, subarachnoid injection of 1% ropivacaine 1.5 ml and 10% glucose injection 0.2 ml. Epidural catheter was inserted. In group PCSNB, patients received ultrasound-guided psoas compartment block (25 ml of 0.375% ropivacaine) combined with sciatic nerve block (20 ml of 0.375% ropivacaine).The application time of the anaesthetic technique and the time of operation, off-bed activity and discharged from hospital were recorded. Intraoperatve blood loss, the volume of fluid transfusion and the dosage of patient controlled analgesia (PCA) drugs were recorded. Meanwhile postoperative adverse effects were evaluated.

Results compared with group GA, the application time were longer in group CSEA and group PCSNB, but the time of operation, off-bed activity and discharged from hospital were shorter. The intraoperatve blood loss and the dosage of patient controlled analgesia (PCA) drugs were more in group GA. The groups CSEA and PCSNB had lower rates of perioperative adverse effects than in group GA.

Conclusion This study just comparison of anesthetic methods for elderly patients at total hip arthroplasty. Combined spinal-epidural anesthesia and combine psoascompartment-sciatic nerve block anesthesia facilitate postoperative recovery when compared with general anesthesia for elderly high risk patients after total hip arthroplasty. Though there are no statistical differences between CSEA and PCSNB, but PCSNB can apply to the patients who have contraindications of intraspinal anesthesia.
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