Chen Peng, Yang Jia, Hu Dandan, Jing Xu, Liu Dajin
Department of Anesthesiology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, Jiangsu 215021, China.
Department of Anesthesiology, Huaian Hospital of Traditional Medicine, Huaian, Jiangsu 223001, China.
Evid Based Complement Alternat Med. 2021 Oct 28;2021:9787879. doi: 10.1155/2021/9787879. eCollection 2021.
To compare the safety of different anesthesia methods combined with intravenous fast channel anesthesia in elderly lower extremity surgery and the effect on postoperative outcome.
A total of 106 elderly patients who underwent lower extremity orthopedic surgery in our hospital from February 2018 to February 2021 were selected and randomly divided into the control group ( = 53) and the observation group ( = 53) according to random number table. All patients received intravenous fast-track anesthesia. On this basis, the control group received spinal-epidural anesthesia, and the observation group received iliac fascial space block on the affected side combined with sciatic nerve block. The operation conditions, blood pressure and heart rate changes, awakening time, postoperative ICU admission rate, and complications were compared between the two groups.
There was no statistical difference in the success rate of one-time operation between the two groups ( > 0.05). The times of using analgesics and vasoactive drugs and the dosage of propofol in the observation group during the operation were lower than those in the control group, and the difference was statistically significant ( < 0.05). At T2, T3, and T4, the levels of HR, DBP, and SBP in the observation group were lower than those in the control group, and the difference was statistically significant ( < 0.05). After operation, the time of awakening, spontaneous breathing recovery, and extubation in the observation group were lower than those in the control group, and the difference were statistically significant ( < 0.05). The incidence of complications in the observation group was lower than that in the control group, the cognitive impairment was the most significant one in the incidence of single complication, and the difference was statistically significant ( < 0.05).
Based on the combined intravenous fast channel anesthesia, the operation difficulty of the affected side iliac fascial space block combined with sciatic nerve block is the same as that of spinal-epidural anesthesia. It has a higher success rate of one operation, better analgesic and anesthetic effects during the operation, and little effect on blood flow of patients. It can maintain relatively stable heart rate and blood pressure and does not easily cause postoperative complications. Its safety is higher than that of spinal-epidural anesthesia.
比较不同麻醉方法联合静脉快通道麻醉用于老年下肢手术的安全性及对术后结局的影响。
选取2018年2月至2021年2月在我院行下肢骨科手术的106例老年患者，按随机数字表法随机分为对照组（n = 53）和观察组（n = 53）。所有患者均接受静脉快通道麻醉。在此基础上，对照组采用腰硬联合麻醉，观察组采用患侧髂筋膜间隙阻滞联合坐骨神经阻滞。比较两组的手术情况、血压和心率变化、苏醒时间、术后ICU入住率及并发症。
两组一次性手术成功率比较，差异无统计学意义（P > 0.05）。观察组术中镇痛药和血管活性药物使用次数及丙泊酚用量均低于对照组，差异有统计学意义（P < 0.05）。在T2、T3和T4时，观察组HR、DBP和SBP水平低于对照组，差异有统计学意义（P < 0.05）。术后，观察组苏醒时间、自主呼吸恢复时间及拔管时间均低于对照组，差异有统计学意义（P < 0.05）。观察组并发症发生率低于对照组，其中认知功能障碍在单项并发症发生率中最为显著，差异有统计学意义（P < 0.05）。
在静脉快通道麻醉基础上，患侧髂筋膜间隙阻滞联合坐骨神经阻滞与腰硬联合麻醉手术难度相当。其一次性手术成功率较高，术中镇痛和麻醉效果较好，对患者血流影响小，可维持心率和血压相对稳定，不易引起术后并发症，安全性高于腰硬联合麻醉。
