年龄因素对不同入路腰硬联合麻醉并发症的影响

目的：探讨年龄因素对腰硬联合麻醉不同穿刺入路并发症的影响。方法：选择2013年3月至2014年3月月中山市中医院收治的符合研究标准的下肢择期手术患者240例作为研究对象，根据年龄分为三组：A组（≤45岁），B组（46～64岁），C组（≥65岁），每组各80例。随机数字表法将每个年龄组患者分为正中入路（M）和旁入路（P）两个亚组。记录硬膜外穿刺困难、异感、出血、术后2、6 d腰背痛发生率。结果：与AM组比较，AP组术后各项并发症，差异无统计学意义（ P＞0.05）。 BP组术后第二天腰痛发生率低于与BM组（P＜0.05）。 CP组术后2、6 d腰痛、穿刺困难发生率均较CM组降低（均P＜0.05）。与CM组比较，AM组术后2、6 d腰痛、穿刺困难、出血发生率明显降低（P＜0.01），BM组术后6 d腰痛、出血发生率降低（P＜0.05）。与CP组比较，AP组穿刺困难、出血发生率降低（P＜0.05），BP组出血发生率降低（ P＜0.05）。结论：年龄相对较轻的患者中，正中入路与旁入路并发症发生率无统计学差异；但随着年龄的增加旁入路并发症的发生率减少。

Effects of age factors in complications of combined spinal-epidural anesthesia by different approaches

Objective：To investigate the effects of age factors in complications of combined spinal-epidural anesthesia by different puncture approaches.Methods：A total of 240 patients, who fulfilled the inclusion criteria and underwent elective operation for lower limbs between…and… in Zhongshan Hospital of Traditional Chinese Medicine, were included as the subjects in the study. And all the patients were divided in to three groups based on the age：Group A （≤45 yrs）, Group B （46～64 yrs）, Group C （≥65 yrs）, with 80 cases in each group. Then, patients in each age group were randomly divided in to two subgroups of Group Middle Approach （ M） and Group Peripheral Approach （P）. The occurrences of epidural puncture difficulty, paresthesia, bleeding, and low back pain after 2 and 6 d of the operation were recorded. Results： There were no statistically significant differences in each complication after the operation between group AP and group AM （ P〉0.05） . The occurrence of backache at the second day after the operation in the BP group was lower than that in the BM group （ P〈0.05） . Compared with group CM, the occurrence of backache, puncture difficulty and bleeding after 2 and 6 d of the operation in group AM were significantly decreased （P〈0.01）, and the occurrence of backache and bleeding after 6 d of the operation in group BM were decreased （P〈0.05）. Compared with group CP, the occurrence of puncture difficulty and bleeding in group AP were decreased （ P〈0.05） , and the occurrence of bleeding in group BP was decreased as well （ P〈0.05） . Conclusion：There are no statistical differences in the occurrence between middle approach complication and peripheral approach complication among younger patients. However, the occurrence of peripheral approach complication decreased along with the increase of age.