摘要目的 探究对高龄下肢骨科手术患者实施外周神经阻滞联合静脉快通道麻醉的效果.方法选取2015年9月至2017年12月宁波第五医院收治的高龄下肢骨科手术患者64例为研究对象,按照麻醉方式的不同将其分为观察组(30例,应用外周神经阻滞联合静脉快通道麻醉)、对照组(34例,应用单纯静脉全身麻醉).比较两组患者的心率、平均动脉压、自主呼吸恢复时间、拔管时间、并发症发生率及认知功能评分.结果 观察组患者T1、T3的心率、平均动脉压与对照组差异均有统计学意义(均P＜0.05);观察组患者自主呼吸恢复时间[(8.32 ±3.26)min]、拔管时间[(9.69 ±4.29)min]均较对照组[(18.24 ±5.23)min、(27.24 ± 4.58)min]明显缩短( t＝8.961、15.756,均P＜0.05);观察组患者术后并发症发生率(3.33%)较对照组(20.59%)低(χ2 ＝4.338,P＜0.05);观察组患者术后4 h、术后8 h的认知功能评分均较对照组高,差异均有统计学意义(t＝6.745、8.494,均P＜0.05).结论 对高龄下肢骨科手术患者实施外周神经阻滞联合静脉快通道麻醉效果显著,患者自主呼吸恢复时间、拔管时间短,且发生谵妄、躁动、恶心呕吐等并发症的风险小.

abstractsObjective To investigate the effect of peripheral nerve block combined with venous fast track anesthesia on elderly patients undergoing lower extremity orthopedic surgery.Methods From September 2015 to December 2017,64 senile patients with lower extremity orthopedic surgery in the Fifth Hospital of Ningbo were selected in the research.According to the different methods of anesthesia , the patients were divided into observation group (30 cases,application of combined intravenous peripheral nerve block and fast track anaesthesia ),and the control group (34 cases, application of simple intravenous general anesthesia ).The heart rate, average arterial pressure, spontaneous breathing recovery time,extubation time,complication rate and cognitive function scores of the two groups were compared.Results The heart rate and average arterial pressure of T 1 and T3 in the observation group were significantly lower than those in the control group ( P＜0.05).The spontaneous breathing recovery time [(8.32 ± 3.26)min] and extubation time[(9.69 ±4.29)min] in the observation group were significantly shorter than those in the control group[(18.24 ±5.23)min and (27.24 ±4.58) min] ( t＝8.961,15.756,all P＜0.05).The incidence rate of postoperative complications in the observation group (3.33%) was significantly lower than that in the control group (20.59%) ( χ2 ＝4.338,P＜0.05).The cognitive function score of the observation group was significantly higher at 4 h and 8 h after surgery than that of the control group ( t ＝6.745,8.494,all P＜0.05).Conclusion Peripheral nerve block combined with intravenous fast －track anesthesia is very feasible for elderly patients undergoing lower limb orthopedic surgery.The time for patients to recover from spontaneous breathing and extubation is shorter , and the risk of complications such as delirium ,restlessness,nausea and vomiting is lower.