【摘要】 目的探讨腰硬联合麻醉与全身麻醉对老年下肢骨折患者手术中血液流变学的影响。方法方便选取2017年2月—2018年9月在该院行下肢骨折手术的108例老年患者作为研究对象,按随机数字法分为对照组(n=54)和研究组(n=54),对照组进行全身麻醉,研究组进行腰硬联合麻醉,对比两组患者全血黏度(高切、低切)、全血还原黏度(高切、低切)、血浆黏度等血液黏度指标及红细胞聚集指数、刚性指数、变形指数、红细胞比容等红细胞相关指标。结果研究组麻醉后10 min的全血高切黏度、全血低切黏度、全血高切还原黏度、全血低切还原黏度、血浆黏度、红细胞聚集指数、红细胞刚性指数、红细胞变形指数、红细胞比容分别为(6.06±1.12)mPa/s、(9.41±1.22)mPa/s、(8.00±1.45)mPa/s、(15.14±1.84)mPa/s、(1.52±0.11)mPa/s、(20.01±1.38)、(6.61±1.07)、(1.02±0.10)、(41.06±2.10);研究组麻醉30min后的全血高切黏度、全血低切黏度、全血高切还原黏度、全血低切还原黏度、血浆黏度、红细胞聚集指数、红细胞刚性指数、红细胞变形指数、红细胞比容分别为(5.84±1.24)mPa/s、(8.21±1.10)mPa/s、(7.06±1.60)mPa/s、(18.36±2.10)mPa/s、(1.48±0.13)mPa/s、(18.69±1.86)、(6.10±1.01)、(1.16±0.12)、(40.12±2.86);研究组术后5 min的全血高切黏度、全血低切黏度、全血高切还原黏度、全血低切还原黏度、血浆黏度、红细胞聚集指数、红细胞刚性指数、红细胞变形指数、红细胞比容分别为(6.13±1.21)mPa/s、(9.08±1.68)mPa/s、(8.89±1.68)mPa/s、(19.40±2.56)mPa/s、(1.50±0.15)mPa/s、(20.03±1.47)、(6.40±1.34)、(1.10±0.10)、(41.01±2.02);均优于对照组的相应指标,差异有统计学意义(P<0.05)。结论腰硬联合麻醉对老年下肢骨折手术患者血液流变学指标的不良影响更小,具有较佳的控制血液黏度的效果,更利于手术的顺利进行和并发症的预防。更多还原

【Abstract】 Objective To investigate the effect of combined spinal-epidural anesthesia and general anesthesia on Hemorheology in elderly patients with lower limb fracture. Methods 108 elderly patients who convenient selection underwent lower limb fracture surgery in the hospital from February 2017 to September 2018 were selected as the research subjects. They were randomly divided into control group(n=54) and research group(n=54). The control group was given general anesthesia,while the research group was given combined spinal-epidural anesthesia. The whole blood viscosity(high shear, low shear),whole blood reduced viscosity(high shear, low shear) and plasma viscosity were compared between the two groups. Blood viscosity index, erythrocyte aggregation index, rigidity index, deformability index, specific volume of erythrocyte and other erythrocyte related indicators. Results In the study group, 10 minutes after anesthesia, the high shear whole blood viscosity,low shear whole blood viscosity, high shear whole blood reduction viscosity, low shear whole blood reduction viscosity, plasma viscosity, erythrocyte aggregation index, erythrocyte rigidity index, erythrocyte deformability index and erythrocyte specific volume were(6.06 ±1.12)mPa/s、(9.41 ±1.22)mPa/s、(8.00 ±1.45)mPa/s、(15.14 ±1.84)mPa/s、(1.52 ±0.11)mPa/s、(20.01 ±1.38)、(6.61±1.07)、(1.02±0.10)、(41.06±2.10); in the study group, 30 minutes after anesthesia, the high shear whole blood viscosity, low shear whole blood viscosity, high shear whole blood reduction viscosity, low shear whole blood reduction viscosity, plasma viscosity, erythrocyte aggregation index,erythrocyte rigidity index, erythrocyte deformability index and erythrocyte specific volume were(5.84 ±1.24)mPa/s、(8.21 ±1.10)mPa/s、(7.06±1.60)mPa/s、(18.36±2.10)mPa/s、(1.48±0.13)mPa/s、(18.69±1.86)、(6.10±1.01)、(1.16±0.12)、(40.12±2.86); in the study group, 5 minutes after operation, the whole blood viscosity of high, low, high, low, plasma, erythrocyte aggregation index, erythrocyte rigidity index, erythrocyte deformability index and erythrocyte specific volume were(6.13 ±1.21)mPa/s、(9.08±1.68)mPa/s、(8.89±1.68)mPa/s、(19.40±2.56)mPa/s、(1.50±0.15)mPa/s、(20.03±1.47)、(6.40±1.34)、(1.10±0.10)、(41.01±2.02); they were significantly better than the corresponding indicators of the control group, the difference was statistically significant(P<0.05). Conclusion Combined spinal-epidural anesthesia has less adverse effect on hemorheological parameters of elderly patients undergoing lower limb fracture surgery, and has better effect of controlling blood viscosity, which is more conducive to the smooth operation and prevention of complications.更多还原