CAJ | 학술논문

目的：探讨不同麻醉方式对髋部骨折手术患者的麻醉效果及术后并发症发生的影响。方法：回顾性分析122例髋部骨折患者临床资料，根据其术中麻醉差异分成A、B、C三组。A组采用腰硬联合麻醉方案，B组采用硬膜外麻醉方案，C组予以气管插管全麻方案。比对三组患者麻醉前、后简易智力状态检查量表（MMSE）评估结果差异，记录其麻醉起效时间、运动阻滞恢复时间、感觉阻滞恢复时间、术后清醒时间及疼痛评分情况，分析其术后相关并发症发生率。结果：（1）麻醉后，三组患者MMSE评估结果均较麻醉前显著降低，但呈逐渐递增趋势，其中A组增幅＞B组＞C组，差异具有统计学意义（P＜0．05）；（2）三组患者中，A组各麻醉时间均显著短于其他两组，其次为B组，C组恢复时间最长（P＜0．05）；术后A组疼痛评分最低为（3．1±0．6）分，其次为B组的（5．2±0．8）分，C组疼痛评分最高为（7．3±0．8）分（P＜0．05）；（3）三组患者均存在术后认知功能障碍问题，其中A、B组发生率对比无统计学意义（P＞0.05）但明显低于C组（P＜0．05）；A、B组患者麻醉后以头痛、血压降低等并发症发生为主，C组患者以低氧血症、躁动、心血管反应及苏醒延迟等并发症为主（P＜0．05）。结论：对髋部骨折患者予以腰硬联合麻醉方案，麻醉效果突出，术后并发症发生风险低，值得临床推广。
목적：탐토불동마취방식대관부골절수술환자적마취효과급술후병발증발생적영향。방법：회고성분석122례관부골절환자림상자료，근거기술중마취차이분성A、B、C삼조。A조채용요경연합마취방안，B조채용경막외마취방안，C조여이기관삽관전마방안。비대삼조환자마취전、후간역지력상태검사량표（MMSE）평고결과차이，기록기마취기효시간、운동조체회복시간、감각조체회복시간、술후청성시간급동통평분정황，분석기술후상관병발증발생솔。결과：（1）마취후，삼조환자MMSE평고결과균교마취전현저강저，단정축점체증추세，기중A조증폭＞B조＞C조，차이구유통계학의의（P＜0．05）；（2）삼조환자중，A조각마취시간균현저단우기타량조，기차위B조，C조회복시간최장（P＜0．05）；술후A조동통평분최저위（3．1±0．6）분，기차위B조적（5．2±0．8）분，C조동통평분최고위（7．3±0．8）분（P＜0．05）；（3）삼조환자균존재술후인지공능장애문제，기중A、B조발생솔대비무통계학의의（P＞0.05）단명현저우C조（P＜0．05）；A、B조환자마취후이두통、혈압강저등병발증발생위주，C조환자이저양혈증、조동、심혈관반응급소성연지등병발증위주（P＜0．05）。결론：대관부골절환자여이요경연합마취방안，마취효과돌출，술후병발증발생풍험저，치득림상추엄。
Objective :To explore the influence of different ways of anesthesia on anesthetic effect of patients with hip fracture operation and postoperative complications .Methods :The clinical datum of 122 patients with hip fractures were retrospectively analyzed .According to the differences of intraoperative anesthesia ,they were divided into A ,B ,C of three groups .Group A was treated with combined spinal and epidural anesthesia ,group B with epidural anesthesia and group C with tracheal intubation general anesthesia scheme .The mini mental state examinations (MMSE) of the three groups before and after the anesthesia were compared .The differences of the results were evaluated .The onset time of anesthesia ,recovery time of motor block and sensory block ,postoperative awake time and scores of pain were recor‐ded .The occurrence rates of postoperative related complications were analyzed .Results:(1)After the anesthesia ,the results of MMSE assessment of the three groups significantly decreased ,compared with those before the anesthesia but there was a gradually increasing trend which was the amplification of group A >group B > group C and the difference was statistically significant (P<0 .05);(2)among the three groups of patients ,the anesthetic time of group A was significantly shorter than that of the other two groups ,followed by the group B and the recovery time of group C was the longest (P<0 .05);after the operation ,the pain score of group A was the lowest (3 .1 ± 0 .6) ,followed by group B (5 .2 ± 0 .8) and the highest score (7 .3 ± 0 .8) of group C (P<0 .05);(3)there were problems of cognitive dysfunc‐tion in all the three groups of patients after the operation among which the contrast of the occurrence rates of group A and B was not statistically significant (P>0 .05) which were significantly lower than that of group C (P<0 .05);the complications of group A and B after the anesthesia mainly were headache ,decreased blood pressure and others while of C group mainly were hypoxemia ,restlessness ,cardiovascular responses and complications such as delayed recovery (P<0 .05) .Conclusion:To treat the patients with hip fracture with combined spinal and epidural anesthesia scheme whose anesthetic effect is prominent can lower the risk of postoperative complications and is worthy of clinical promo‐tion .