【摘要】 目的:比较单侧腰麻与全身麻醉（简称全麻）在老年慢性阻塞性肺疾病（COPD）患者行髋关节置换术中的效果。方法:选取2024年1月—2025年6月于荆州市第三人民医院行髋关节置换术的老年COPD患者100例,采用随机数字表法分为A组（单侧腰麻,n=50）和B组（全麻,n=50）。比较两组不同时间点[麻醉前（T₀）、麻醉后5 min（T₁）、麻醉后10 min（T₂）、麻醉后30 min（T₃）、术毕时（T₄）、入麻醉后监测治疗室（PACU）即刻（T₅）、入PACU后30 min（T₆）]的血流动力学指标,比较两组术前及术后1、3 d认知功能评分,比较两组的麻醉与手术相关指标及不良反应、肺部并发症、心血管不良事件发生率。结果:T₁～T₅,A组MAP和血氧饱和度（SpO₂）高于B组,HR低于B组（P<0.05）。A组术后镇痛药物追加次数少于B组,但双下肢肌力恢复时间及自主排尿时间晚于B组（P<0.05）。术后1、3 d,A组简易智能状态量表（MMSE）和蒙特利尔认知评估量表（MoCA）评分高于B组（P<0.05）。A组不良反应、肺部并发症和心血管不良事件发生率均低于B组（P<0.05）。结论:单侧腰麻在老年COPD患者行髋关节置换术中具有更好的血流动力学稳定性、更优的认知功能保护作用及更低的不良反应及肺部并发症发生率,而全麻在术后肌力恢复和自主排尿方面恢复更快。更多还原

【Abstract】 Objective: To compare the effects of unilateral spinal anesthesia and general anesthesia（referred to as general anesthesia） in hip replacement surgery for elderly patients with chronic obstructive pulmonary disease（COPD）. Method: A total of 100 elderly COPD patients who underwent hip replacement surgery in the Third People’s Hospital of Jingzhou from January 2024 to June 2025 were selected and divided into group A（unilateral spinal anesthesia, n=50） and group B（general anesthesia, n=50） by random number table method. The hemodynamic indicators at different time points [before anesthesia（T₀）, 5 minutes after anesthesia（T₁）, 10 minutes after anesthesia（T₂）, 30 minutes after anesthesia（T₃）, at the end of the operation（T₄）, immediately after entering the post-anesthesia care unit（PACU）（T₅）, 30 minutes after entering the PACU（T₆）] of the two groups were compared. The cognitive function scores of the two groups before the operation and on the 1 and 3 days after the operation were compared. The anesthesia and surgery-related indicators, as well as the incidences of adverse reactions, pulmonary complications and cardiovascular adverse events were compared between the two groups. Result: At time points T₁ to T₅, the MAP and blood oxygen saturation（SpO₂） in group A were higher than those in group B, while HR was lower than that in group B（P<0.05）. The number of additional postoperative analgesic drugs in group A was less than that in group B, the recovery time of muscle strength in both lower extremities and the time of spontaneous urination were later than those in group B（P<0.05）. At 1 and 3 days after the operation, the scores of the mini-mental state examination（MMSE） and the Montreal cognitive assessment scale（MoCA） in group A were higher than those in group B（P<0.05）. The incidences of adverse reactions, pulmonary complications and cardiovascular adverse events in group A were all lower than those in group B（P<0.05）. Conclusion: Unilateral spinal anesthesia has better hemodynamic stability, superior cognitive function protection, and lower incidence of adverse reactions and pulmonary complications in elderly patients with COPD undergoing hip replacement surgery. General anesthesia, on the other hand, leads to a faster recovery in muscle strength and voluntary urination after surgery.更多还原