Park Hye Jin, Kang Hyoseok, Lee Jae-Woo, Baek Seung Min, Seo Jeong Seung
Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
Korean J Anesthesiol. 2015 Feb;68(1):37-42. doi: 10.4097/kjae.2015.68.1.37. Epub 2015 Jan 28.
The old age population, including the very old aged (≥ 85 years), is rapidly increasing, and femur neck fracture from accidents is commonly seen in the elderly. Use of bone cement during bipolar hemiarthroplasty can cause bone cement implantation syndrome.
This study was prospectively conducted on the elderly who were scheduled to undergo elective cemented bipolar hemiarthroplasty under spinal anesthesia. Patients were divided into 2 groups: the old age (65-84 years) and very old age groups (≥ 85 years). Hemodynamic parameters were recorded at the following time points: the start of the operation, femoral reaming, cement insertion, every 2 minutes after cement insertion for 10 minutes, femoral joint reduction, and the end of operation. When hypotension occurred, ephedrine was given.
Sixty-five patients in the old age group and 32 patients in the very old age group were enrolled. Mean ages were 78.9 and 89.4 years, respectively, in the old age and very old age groups. The very old age group showed constantly decreased levels of cardiac index and stroke volume from cementing until the end of the operation compared to the old age group. To maintain hemodynamic stability after cement insertion, the requirement of ephedrine was higher in the very old age group than in the old age group (13.52 ± 7.76 vs 8.65 ± 6.38 mg, P = 0.001).
Bone cement implantation during bipolar hemiarthroplasty may cause more prominent hemodynamic changes in very elderly patients. Careful hemodynamic monitoring and management are warranted in very elderly patients undergoing cemented bipolar hemiarthroplasty.
老年人群，包括高龄老人（≥85岁），数量正在迅速增加，因意外导致的股骨颈骨折在老年人中很常见。在双极半髋关节置换术中使用骨水泥可引发骨水泥植入综合征。
本研究前瞻性地纳入了计划在脊髓麻醉下接受择期骨水泥型双极半髋关节置换术的老年人。患者分为两组：老年组（65 - 84岁）和高龄组（≥85岁）。在以下时间点记录血流动力学参数：手术开始时、股骨扩髓时、骨水泥植入时、骨水泥植入后每2分钟共10分钟、股骨关节复位时以及手术结束时。出现低血压时给予麻黄碱。
老年组纳入65例患者，高龄组纳入32例患者。老年组和高龄组的平均年龄分别为78.9岁和89.4岁。与老年组相比，高龄组从骨水泥植入直至手术结束时心脏指数和每搏输出量持续下降。为维持骨水泥植入后的血流动力学稳定，高龄组麻黄碱的需求量高于老年组（13.52±7.76 vs 8.65±6.38 mg，P = 0.001）。
双极半髋关节置换术中骨水泥植入可能在高龄患者中引起更显著的血流动力学变化。对于接受骨水泥型双极半髋关节置换术的高龄患者，有必要进行仔细的血流动力学监测和管理。
