目的:对比利多卡因、罗哌卡因腰硬联合麻醉(CSEA)对老年股骨颈骨折患者血流动力学及认知功能的影响.方法:回顾性分析天津市北辰医院麻醉科在2019年7月—2022年6月期间进行老年股骨颈骨折手术的患者67例,其中采用CSEA者31例(CSEA组),全身麻醉36例(全麻组).比较两组患者麻醉后不同时间点血流动力学、意识及不良反应.结果:全麻组术后3h和6h时间点收缩压显著低于CSEA组,1 h和6 h心率低于CSEA组,差异有统计学意义(P<0.05);CSEA组起效时间、意识恢复时间和完全清醒时间优于全麻组,差异有统计学意义(P<0.05);CSEA组麻醉 24、72 h MMS评分高于全麻组,差异有统计学意义(P<0.05),而两组其他时间段MMS评分比较,差异无统计学意义(P>0.05);全麻组不良事件发生率高于CSEA组,差异有统计学意义(P<0.05).结论:CSEA与全麻相比在老年股骨颈骨折麻醉方而效果更好,对患者认知功能和血流动力学指标影响更小,不良事件发生率更低.
Comparison of the Effect of Combined Epidural Anesthesia and General Anesthesia in Elderly Patients with Femoral Neck Fracture
Objective:To compare the effects of lidocaine and ropivacaine combined spinal epidural anesthesia(CSEA)on hemodynamics and cognitive function in elderly patients with femoral neck fractures.Methods:A retrospective analysis was conducted on 67 patients who underwent surgery for femoral neck fractures in the elderly at the Anesthesia Department of Tianjin Beichen Hospital from July 2019 to June 2022.Among them,31 patients received CSEA(CSEA group)and 36 patients received general anesthesia(general anesthesia group).The hemodynamics,consciousness and adverse reactions at different time points after anesthesia were compared between the two groups.Results:The systolic blood pressure at 3 and 6 hours after surgery in the general anesthesia group was significantly lower than that in the CSEA group,and the heart rate at 1 and 6 hours was lower than that in the CSEA group,with a statistically significant difference(P<0.05);The onset time,consciousness recovery time,and complete awakening time of the CSEA group were better than those of the general anesthesia group,with a statistically significant differences(P<0.05).The MMS scores of the CSEA group at 24 and 72 hours of anesthesia were higher than those of the general anesthesia group,with a statistically significant difference(P<0.05).However,there was no statistically significant difference in MMS scores between the two groups at other time periods(P>0.05).The incidence of adverse events in the general anesthesia group was higher than that in the CSEA group,with a statistically significant differences(P<0.05).Conclusion:Compared with general anesthesia,CSEA has a better effect on anesthesia for elderly femoral neck fractures,has less impact on cognitive function and hemodynamic indicators,and has a lower incidence of adverse events.
Combined spinal epidural anesthesiaGeneral anesthesiaOld ageSurgery for femoral neck fracture
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