Influence of combined general-epidural anesthesia on hemodynamic parameters after surgery for fractures of the lower extremity in elderly patients by using pulse-indicated continuous cardiac output monitoring
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摘要: 目的 采用连续心排量(PICCO)技术分析全麻联合硬膜外麻醉在老年下肢骨科手术中的应用优势。 方法 将83例老年下肢骨折患者随机分为2组,均行人工股骨头置换术,对照组采用全身麻醉,观察组给予全身麻醉复合硬膜外麻醉。采用PICCO技术监测血流动力学指标[心排量指数(CI)、全心舒张末期容积(GEDVI)、胸内血容量指数(ITBVI)、血管外肺水指数(EVLWI)],观察2组常规生理指标[心率(HR)、收缩压(SBP)、舒张压(DBP)及中心静脉压(CVP)],并统计术后并发症情况。 结果 患者常规生理指标和血流动力学指标同时受到组别与时间的影响(P<0.05),组别和时间无交互作用(P>0.05)。T0和T4时,HR、SBP、DBP及CVP的组间差异无统计学意义(P>0.05),T1~T3时,观察组HR、SBP、DBP及CVP水平均低于对照组(P<0.05);T0时,CI、GEDVI、ITBVI及EVLWI的组间差异无统计学意义(P>0.05),T1~T4时,观察组CI、GEDVI、ITBVI水平高于对照组,EVLWI低于对照组(P<0.05)。另外,观察组随访期深静脉血栓发生率和认知功能损伤发生率均低于对照组(P<0.05)。 结论 全麻联合硬膜外麻醉在维持老年下肢骨科手术患者的血流动力学稳定性方面,优于全身麻醉,更加利于改善患者预后。Abstract: 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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