本文選題：髖關(guān)節(jié)置換術(shù) + 靜脈麻醉��； 參考：《微循環(huán)學(xué)雜志》2016年04期

【摘要】：目的:比較髖關(guān)節(jié)置換術(shù)行靜脈全麻和腰-硬膜外麻醉患者的血流動力學(xué)和血液流變學(xué)指標變化。方法:92例髖關(guān)節(jié)置換術(shù)患者按隨機數(shù)字表法分為靜脈全麻組和腰-硬膜外麻醉組,每組各46例。靜脈全麻組行氣管內(nèi)插管后微量泵靜脈給予瑞芬太尼(0.1-0.5μg/kg/h)和丙泊酚(4-6mg/h),腰-硬膜外麻醉組行L2-3腰-硬膜外穿刺給藥予0.5%左布比卡因2ml。對比兩組麻醉前(T0)、麻醉5min(T1)、麻醉30min(T2)及術(shù)后5min(T3)、30min(T4)的血流動力學(xué)和血液流變學(xué)指標以及藥物起效、阻滯完成時間和麻醉并發(fā)癥發(fā)生率的差異。結(jié)果:兩組T0血流動力學(xué)及血液流變學(xué)指標差異無統(tǒng)計學(xué)意義(P0.05)。腰-硬膜外麻醉組T1、T2、T3、T4時血壓(BP)、心率(HR)、血氧飽和度(SPO2)均明顯高于靜脈全麻組(P0.05),全血黏度、全血還原黏度、血漿黏度亦明顯高于靜脈全麻組(P0.05)。腰-硬膜外麻醉組內(nèi)各時相的BP、HR、SPO2、全血黏度、全血還原黏度、血漿黏度均無明顯差異(P0.05);而靜脈全麻組內(nèi)各時相上述各指標均存在明顯差異(P0.05),T1-T4均低于T0(P0.05)。同時,腰-硬膜外麻醉組麻醉起效時間、阻滯完全時間短于靜脈全麻組(P0.05)。兩組均未發(fā)生藥物不良反應(yīng)和麻醉并發(fā)癥。結(jié)論:髖關(guān)節(jié)置換術(shù)患者采用腰-硬膜外麻醉更合適。
[Abstract]:Objective: to compare the changes of hemodynamics and hemorheology in patients undergoing general intravenous anesthesia and spinal-epidural anesthesia after hip arthroplasty. Methods 92 patients with hip arthroplasty were randomly divided into general intravenous anesthesia group and spinal-epidural anesthesia group with 46 cases in each group. After endotracheal intubation, intravenous infusion of remifentanil 0.1-0.5 渭 g / kg 路kg / h and propofol 4-6 mg / h were performed in the general anesthesia group, and 0.5% levobupivacaine was given to the L2-3 lumbar epidural puncture in the spinal-epidural anesthesia group. The difference of hemodynamics, hemorheology, effect of drugs, time of completion of block and incidence of complications of anesthesia were compared between the two groups before anesthesia, 5 min after anesthesia, 30 min after anesthesia and 5 min after operation. Results: there was no significant difference in T 0 hemodynamics and hemorheology between the two groups (P 0.05). The blood pressure, heart rate and blood oxygen saturation in the spinal-epidural anesthesia group were significantly higher than those in the intravenous general anesthesia group (P 0.05). The whole blood viscosity, whole blood reduction viscosity and plasma viscosity were also significantly higher than those in the intravenous general anesthesia group (P 0.05). There was no significant difference in SPO _ 2, whole blood viscosity, whole blood reduction viscosity and plasma viscosity in all phases of Spinal epidural anesthesia group (P 0.05), but there were significant differences in each time phase above mentioned above in intravenous general anesthesia group (P 0.05) and T _ (1-T _ 4) were lower than that in T _ 0 P _ (0.05) T _ (0.05). At the same time, the onset time and complete block time of spinal-epidural anesthesia group were shorter than that of intravenous general anesthesia group (P 0.05). There were no adverse drug reactions and anesthetic complications in both groups. Conclusion: lumbar epidural anesthesia is more suitable for hip arthroplasty.
【作者單位】： 北京中醫(yī)醫(yī)院順義醫(yī)院麻醉科;
【分類號】：R614

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