Objective To assess the advantage of combined general-epidural anesthesia in the surgery for fractures of the lower extremity in elderly patients by using pulse-indicated continuous cardiac output (PICCO) monitoring.
Methods Eighty-there elderly patients with lower limb fracture undergoing prosthetic replacement surgery were enrolled and divided into 2 groups.The general anesthesia was performed in the control group,while the combined general-epidural anesthesia was performed in the observation group.PICCO was used to monitor the changes of hemodynamic parameters,such as cardiac index (CI),global end-diastolic volume index (GEDVI),intrathoracic blood volume index (ITBVI) and extra-vascular lung water index (EVLWI).The normal physiological indexes such as heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP) and central venous pressure (CVP) were also compared between the two groups.And the incidence of complication in the follow-up was recorded too.
Results The normal physiological indexes and hemodynamic indexes were difference between difference group and time points (
P<0.05),and there was no interaction between group factor and time factor (
P>0.05).At the time of T0 and T4,there was no significant difference in HR,SBP,DBP and CVP between the two groups (
P>0.05);from T1 to T3,the level of HR,SBP,DBP and CVP in the observation group were all lower than those in the control group (
P<0.05).At the time of T0,there was no significant difference in CI,GEDVI,ITBVI and EVLWI between the two groups (
P>0.05);from T1 to T4,the level of CI,GEDVI and ITBVI in the observation group were all higher than those in the control group,and the level of EVLWI in the observation group was lower than that in the control group (
P<0.05).Furthermore,the incidence of deep vein thrombosis and cognitive impairment in the observation group were both lower than those in the control group (
P<0.05).
Conclusion The combined general-epidural anesthesia can stably maintain hemodynamic parameters in elderly patients undergoing the surgery for fractures of the lower extremity when compared with general anesthesia,which is more conducive to the improvement of prognosis of patients.
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