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| 不同麻醉方式对老年患者经皮椎体成形术后恢复质量的影响 |
| Effect of different anesthesia methods on the postoperative recovery quality of percutaneous vertebroplasty in elderly patients |
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| DOI：10.12089/jca.2025.09.005 |
| 中文关键词: 高流量氧疗 老年 椎体成形术 监护麻醉 恢复质量 |
| 英文关键词: High flow oxygen therapy Aged Vertebroplasty Monitored anesthesia care Quality of recovery |
| 基金项目:无锡市卫生健康委面上项目（M202233）；无锡市“双百”中青年医疗卫生人才培养计划项目（BJ2023110） |
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| 中文摘要: |
目的：探讨不同麻醉方式对老年患者经皮椎体成形术后恢复质量的影响。
方法：选择择期行经皮椎体成形术老年患者89例，男41例，女48例，年龄65～85岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ—Ⅲ级。将患者随机分为两组：监护麻醉组（M组，n=45）和插管全麻组（G组，n=44）。两组均用1%利多卡因15 ml局部浸润麻醉。M组采用监护麻醉，予以经鼻高流量氧疗，俯卧位后静脉注射艾司氯胺酮0.5 mg/kg和静脉泵注右美托咪定0.3 μg/kg，维持采用艾司氯胺酮0.15～0.35 mg·kg-1·h-1和右美托咪定0.2～0.4 μg·kg-1·h-1静脉泵注，术中保留自主呼吸。G 组采用常规气管插管全麻，术中行机械通气。记录在术中和PACU期间低血压、高血压、低氧血症、体动、追加麻醉药物例数和PACU 停留时间。记录术前1 d、术后1、2、7 d 15项恢复质量（QoR-15）评分。记录术后恶心呕吐、头晕、谵妄和肺部感染等不良反应的发生情况。
结果：与G组比较，M组PACU停留时间明显缩短（P<0.05）， 术后1 d QoR-15评分明显升高（P<0.05）。两组术前1 d、术后2和7 d QoR-15评分差异无统计学意义。两组低血压、高血压、低氧血症、体动、追加麻醉药物例数和术后不良反应发生率差异无统计学意义。
结论：监护麻醉联合经鼻高流量氧疗可缩短行经皮椎体成形术老年患者PACU停留时间，提高术后恢复质量。 |
| 英文摘要: |
Objective: To investigate the effect of different anesthesia methods on the postoperative recovery quality of percutaneous vertebroplasty in elderly patients.
Methods: Eighty-nine elderly patients who underwent percutaneous vertebroplasty in our hospital were selected, 41 males and 48 females, aged 65-85 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ—Ⅲ. All the patients were randomly divided into two groups: monitored anesthesia care group (group M, n = 45) and intubation general anesthesia group (group G, n = 44). Both groups were given 15 ml local infiltration anesthesia with 1% lidocaine. Group M received monitoring anesthesia care and was given high-flow nasal oxygen therapy, esketamine 0.5 mg/kg intravenously and dexmedetomidine 0.3 μg/kg intravenously by pump after prone position, esketamine 0.15-0.35 mg·kg-1·h-1 and dexmedetomidine 0.2-0.4 μg·kg-1·h-1 intravenously were maintained, and spontaneous breathing was preserved during the operation. Group G was treated with conventional tracheal intubation and general anesthesia, treated with mechanical ventilation during the surgery. Hypotension, hypertension, hypoxemia, number of body movements, additional anesthetics and PACU stay time were recorded during the operation and PACU. The preoperative 1 day, postoperative 1, 2 and 7 days 15-item quality-of-recovery (QoR-15) scores were recorded. Postoperative adverse reactions such as nausea, vomiting, dizziness, delirium and pulmonary infection were recorded.
Results: Compared with group G, group M had significantly shortly PACU stay time and higher QoR-15 scores on the first postoperative day (P < 0.05). There were no statistically significantly differences between the two groups in QoR-15 scores on preoperative 1 day, postoperative 2 and 7 days, and the incidence of hypotension, hypertension, hypoxemia, body movements, additional anesthetics, postoperative adverse reactions.
Conclusion: Monitored anesthesia care combined with high flow nasal cannula oxygen therapy can shorten PACU stay time and improve postoperative recovery quality in elderly patients undergoing percutaneous vertebroplasty. |
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