硬膜外麻醉与腰硬联合麻醉对下肢骨折患者Bromage评分及肺部感染发生的影响

Effects of epidural anesthesia and combined spinal and epidural anesthesia on bromage score and pulmonary infection in patients with lower extremity fracture

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摘要目的:分析硬膜外麻醉与腰硬联合麻醉对下肢骨折患者Bromage评分及肺部感染发生的影响。方法:选取2021年1月至2023年1月于鹤壁煤业(集团)有限责任公司总医院就诊并行手术治疗的下肢骨折患者218例,均由麻醉师、患者及家属选定麻醉方式,以此分为全麻组(全身麻醉治疗,n=61)、硬麻组(硬膜外麻醉治疗,n=101)和腰硬麻组(腰硬联合麻醉,n=56)。观察每组患者麻醉效果、下肢改良Bromage评分、手术前后呼吸功能指标变化以及术后肺部感染发生状况。结果:腰硬膜组感觉阻滞起效时间、恢复时间、麻醉药物使用量分别为(5.31±2.37)s、(6.60±3.26)s、(6.07±0.77)mg,均低于全麻组的(10.26±4.41)s、(24.43±6.32)s、(63.38±9.38)mg和硬麻组的(9.84±3.46)s、(16.26±5.91)s、(36.36±1.18)mg,差异有统计学意义(P<0.05);在Bromage评分中,腰硬麻组3级比例为91.07%,高于全麻组的49.18%和硬麻组的51.49%,差异有统计学意义(P<0.05);经重复测量数据方差分析,以时间因素为源的主体内效应比较,3组呼吸功能指标差异有统计意义(F时点=6397.053、122.641、28.043,P<0.05),以时间因素与组别的交互作用为源的主体内效应比较,除MV外均有统计意义(F交互=395.351、16.083,P<0.05),以组别为源的主体间效应比较,差异有统计意义(F组间=182.299、6.729、3.606,P<0.05);腰硬麻组SpO_(2)、MV分别为(95.23±1.46)%、(7.74±4.13)L/min,均高于全麻组的(89.76±1.35)%、(6.46±3.26)L/min和硬麻组的(90.13±1.42)%、(6.25±3.74)L/min,RR为(20.77±6.41)mg/L,低于全麻组的(26.76±7.36)mg/L和硬麻组的(27.12±7.45)mg/L,差异有统计学意义(P<0.05);腰硬麻组发生肺部感染的概率为1.79%,低于全麻组的11.48%和硬麻组的10.89%,差异有统计学意义(P<0.05)。结论:腰硬联合麻醉用于下肢骨折治疗,麻醉效果显著,且起效快、用量少,能够帮助患者术后改善呼吸功能以及减少肺部感染的发生。 Objective:Effects of epidural anesthesia and combined spinal and epidural anesthesia on Bromage score and pulmonary infection in patients with lower extremity fracture were investigated.Methods:From January 2021 to January 2023,218 patients with lower limb fracture who received treatment in Hebi Coal Industry(Group)limited liability company general hospital for concurrent operation were selected by anesthesiologists,patients and their families,and were divided into general anesthesia group(general anesthesia treatment,n=61),hard anesthesia group(epidural anesthesia treatment,n=101)and lumbar hard anesthesia group(combined spinal and epidural anesthesia,n=56).Anesthesia effect,lower extremity modified Bromage score,changes of respiratory function index before and after operation,and postoperative pulmonary infection were observed in each group.Results:In lumbar dural group,the onset time of sensory block,recovery time and the amount of narcotic drugs were(5.31±2.37)s,(6.6±3.26)s and(6.07±0.77)mg,respectively.They were lower than that of(10.26±4.41)s,(24.43±6.32)s,(63.38±9.38)mg in general anesthesia group and(9.84±3.46)s,(16.26±5.91)s,(36.36±1.18)mg in hard anesthesia group,and the difference was statistically significant(P<0.05).In Bromage score,the proportion of grade 3 in lumbar hard anesthesia group was 91.07%,which was higher than that in general anesthesia group 49.18%and hard anesthesia group 51.49%,and the difference was statistically significant(P<0.05).Through ANOVA of repeated measurement data,comparison of intra-subject effects based on time factors showed statistically significant differences in respiratory function indexes among the three groups(F time point=6397.053,122.641,28.043,P<0.05).Comparison of intra-subject effects based on interaction between time factors and groups showed that:All subjects except MV were statistically significant(F interaction=395.351,16.083,P<0.05),and inter-subject effect comparisons based on groups were statistically significant(F interaction=182.299,6.729,3.606,P<0.05).SpO_(2) and MV in the lumbar hard anesthesia group were(95.23±1.46)%and(7.74±4.13)L/min,respectively,higher than those in the general anesthesia group(89.76±1.35)%and(6.46±3.26)L/min and the hard anesthesia group(90.13±1.42)%and(6.25±3.74)L/min,respectively.The RR of(20.77±6.41)mg/L was lower than that of(26.76±7.36)mg/L in general anesthesia group and(27.12±7.45)mg/L in hard anesthesia group,and the difference was statistically significant(P<0.05).The probability of pulmonary infection in the lumbar hard anesthesia group was 1.79%,which was lower than 11.48%in the general anesthesia group and 10.89%in the hard anesthesia group,and the difference was statistically significant(P<0.05).Conclusion:Combined spinal and epidural anesthesia is used for the treatment of lower limb fracture,and the anesthetic effect is remarkable,and the effect is fast and the dosage is small,which can help patients improve respiratory function and reduce the occurrence of lung infection after surgery.

作者方园孔德华李安超 FANG Yuan;KONG Dehua;LI Anchao(Hebi Coal Industry(Group)Co.,Ltd.General Hospital Anesthesia Room,Hebi 458000,China)

机构地区鹤壁煤业(集团)有限责任公司总医院麻醉科

出处《黑龙江医药科学》 2024年第6期106-110,共5页 Heilongjiang Medicine and Pharmacy

关键词骨折下肢硬膜外麻醉腰硬联合麻醉下肢运动阻滞程度评分感染 fracture lower limb epidural anesthesia combined spinal and epidural anesthesia bromage score infection

分类号 R614 [医药卫生—麻醉学]

作者简介方园(1989-),男,河南浚县人,本科,主治医师。