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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
轻比重布比卡因腰麻对行PFNA术老年患者麻醉效果及循环呼吸系统影响
Effects of light-weight bupivacaine spinal anesthesia on anesthesia and circulatory system in elderly patients undergoing PFNA
投稿时间:2019-04-11  修订日期:2019-04-11
DOI:
中文关键词:  布比卡因;轻比重;防旋股骨近端髓内钉;股骨粗隆间骨折;循环呼吸系统
英文关键词:bupivacaine; light specific gravity; anti-rotation proximal femoral nail; femoral intertrochanteric fracture; circulatory respiratory system
基金项目:
作者单位E-mail
彭春潮 青海省人民医院 pyong718@sohu.com 
吴婧文 青海省人民医院 34918405@qq.com 
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中文摘要:
      目的 探究轻比重布比卡因腰麻对行防旋股骨近端髓内钉术(PFNA)老年患者麻醉效果及循环呼吸系统影响。方法 选择2015年8月至2018年8月在我院行PFNA术的60例老年患者作为研究对象,随机分为2组,每组30例。重比重组使用3 mL含0.5%布比卡因的葡萄糖溶液麻醉,轻比重组使用6 mL含0.25%布比卡因的蒸馏水溶液麻醉。比较两组麻醉效果。检测并比较两组麻醉前(T0)、麻醉平面固定后(T1)、用药后5min(T2)、15min(T3)、30min(T4)和1h(T5)的镇静程度、循环呼吸系统变化。使用简易精神情况量表(MMSE)评估患者认知情况。统计期间患者不良反应发生情况。 结果 两组的麻醉起效时间基本一致(P>0.05)。轻比重组麻醉组织平面≥T10的比例显著低于重比重组(P<0.05)。轻比重组的麻黄碱和阿托品的使用率显著低于重比重组(P<0.05)。两组患者T0~T5 Ramsay评分差异无统计学意义(P>0.05)。麻醉前两组患者MAP、心率、收缩压、舒张压、呼吸频率和SpO2差异无统计学意义(P>0.05),麻醉后T2~T5时间点两组患者MAP、心率、收缩压、舒张压、呼吸频率和SpO2均显著降低,但重比重组降低更为显著(P<0.05)。麻醉后轻比重组的MMSE评分高于重比重组(P<0.05),并且轻比重组的认知功能障碍发生率显著低于重比重组(P<0.05)。重比重组和轻比重组不良反应发生率分别为46.67%和23.33%。 结论 对行PFNA术的老年患者采用低浓度腰麻阻滞能够获得满意麻醉效果,对循环呼吸系统影响较小,有效改善患者麻醉恢复期质量,而且安全性较高,值得在临床进一步应用。
英文摘要:
      Objective To investigate the effects of light-weight bupivacaine on the anesthetic effect and respiratory and respiratory effects of elderly patients with anti-rotation femoral proximal intramedullary nailing (PFNA). Methods Sixty elderly patients who underwent PFNA in our hospital from August 2015 to August 2018 were randomly divided into two groups, 30 in each group. The weight was anesthetized with 3 mL of glucose solution containing 0.5% bupivacaine. Lightly anesthetized with 6 mL of distilled water containing 0.25% bupivacaine. Compare the anesthetic effects of the two groups. The sedation and circulatory system changes before and after anesthesia (T0), anesthesia plane fixation (T1), 5 min (T2), 15 min (T3), 30 min (T4), and 1 h (T5) were measured and compared. Patients' cognitive status was assessed using the Mini Mental Condition Scale (MMSE). The incidence of adverse reactions in patients was counted. Results: The anesthetic onset time were basically the same (P>0.05). The ratio of light to specific anesthesia tissue plane ≥T10 was significantly lower than that of weight ratio recombination (P < 0.05). The use rate of lighter than recombinant ephedrine and atropine was significantly lower than that of weight-to-recombinant (P<0.05). There was no significant difference in T0~T5 Ramsay score between the two groups (P>0.05). There was no significant difference in MAP, heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate and SpO2 between the two groups before anesthesia (P>0.05). At the T2~T5 time point after anesthesia, MAP, heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate and SpO2 were significantly lower in the two groups, but the weight was more significant than the recombination (P<0.05). After anesthesia, the lighter than recombinant MMSE score was higher than the weight ratio recombination (P<0.05). The incidence of cognitive dysfunction was significantly lower than that of recombinant recombination (P<0.05). The incidence of adverse reactions in weight-to-recombination and light-weight recombination were 46.67% and 23.33%, respectively. Conclusion: The low concentration of spinal anesthesia in senile patients undergoing PFNA can achieve satisfactory anesthetic effect, with less effect on the circulatory system, effectively improve the quality of anesthesia recovery, and have higher safety, it is worth further application in clinical practice.
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