硬膜外麻醉复合小剂量静脉麻醉在全髋关节置换术中的麻醉效果及安全性分析

Efficacy and safety of epidural anesthesia combined with low-dose intravenous anesthesia in total hip arthroplasty

摘要:

目的?观察硬膜外麻醉复合小剂量静脉麻醉在全髋关节置换术患者围手术期的疗效和安全性。 方法?选取2016年1月—2018年12月在凉山彝族自治州第二人民医院行全髋关节置换术的患者74例，按随机数字法分为观察组与对照组，每组37例。对照组采用连续硬膜外麻醉，观察组采用硬膜外麻醉复合小剂量静脉麻醉。观察两组术中一般情况、围手术期血流动力学变化；同时观察两组不良反应发生情况。结果?观察组与对照组在麻醉前、麻醉完成时间、切皮时、术毕即刻、术后30?min的SPO2、PetCO2和Ppeak比较，采用重复测量设计的方差分析，结果：①不同时间点SPO2、PetCO2和Ppeak无差异（P?>0.05）；②两组的SPO2、PetCO2和Ppeak比较无差异（P?>0.05）；③两组SPO2、PetCO2和Ppeak变化趋势无差异（P?>0.05）。两组不同时间点HR、MAP比较，采用重复测量设计的方差分析，结果：①不同时间点HR、MAP有差异（P?<0.05）；②两组HR、MAP有差异（P?<0.05）；③两组HR、MAP变化趋势有差异（P?<0.05）。两组麻醉时间比较，差异无统计学差异（P?>0.05）。两组VAS评分在不同时间、不同组间及变化趋势上有差异（P?<0.05）。观察组恶心呕吐、心动过缓发生率低于对照组（P?<0.05）。结论 硬膜外麻醉复合小剂量静脉麻醉可维持术中血流动力学稳定，在全髋置换术中具有较好的疗效。

Abstract:

Objective To observe the perioperative efficacy and safety of epidural anesthesia combined with low-dose intravenous anesthesia in total hip arthroplasty. ?Methods? Seventy-four patients who underwent total hip arthroplasty in our department from January 2016 to December 2018 were enrolled. The patients were divided into observation group and control group according to random number method, with 37 cases in each group. Continuous epidural anesthesia was used in the control group, while the observation group was treated with epidural anesthesia combined with low-dose intravenous anesthesia. The general conditions of the operation, perioperative hemodynamic changes, and the occurrence of adverse reactions were observed. ?Results? The levels of SPO2, PetCO2 and Ppeak were observed before anesthesia, right after anesthesia, at skin incision, right after surgery and 30 min after surgery, and no significant difference was found among different time points or between the two groups (P > 0.05). The heart rate (HR) and mean arterial pressure (MAP) at distinct time points and between the two groups were significantly different, and the change trends of HR and MAP were as well different between the observation group and control group (P < 0.05). There was no significant difference in anesthesia time between the two groups (P > 0.05). The visual analogue scale (VAS) scores in the control group 24 h and 48 h after operation were significantly higher than those in the observation group (P < 0.05). The incidence of nausea, vomiting and bradycardia in the observation group was significantly lower than that in the control group (P < 0.05).?Conclusions?Epidural anesthesia combined with low-dose intravenous anesthesia can maintain intraoperative hemodynamic stability and has a good therapeutic efficacy in total hip arthroplasty.