中文摘要：

目的比较不同麻醉方式联合静脉快通道麻醉在老年患者下肢微创骨科手术中的应用。方法前瞻性收集2016年5月至12月于河北医科大学第三医院行膝关节镜手术的患者60例，其中男性32例（53%），女性28例（47%），年龄65～85岁，BMI21～29kg/m2。采用随机数字表法分为3组：手术部位局部浸润麻醉+静脉快通道麻醉组（LP组，n=20）、患侧髂筋膜间隙阻滞联合坐骨神经阻滞+静脉快通道麻醉组（NP组，n=20）及蛛网膜下腔阻滞+静脉快通道麻醉组（SP组，n=20）。三组患者于切皮前经静脉注射丙泊酚0.5～1mg/kg，继而持续泵注0.06～0.1mg/kg/min的丙泊酚至术毕，维持术中脑电双频指数（BIS）值50～60。记录并比较各组患者单次操作成功率、术中血压、心率、血氧饱和度、BIS值、丙泊酚用量、镇痛药和血管活性药物应用情况、辅助通气情况、苏醒时间、术后并发症发生率及住院时间。结果三组患者术中均未发生不良事件。与LP组比较，NP组和SP组术中辅助呼吸应用率（c2=4.263，P＜0.05）、镇痛药物应用率（c2=3.392，P＜0.05）、丙泊酚用量（q=4.983，q=5.284，P＜0.05）及术后苏醒时间（q=3.408，q=54.172，P＜0.05）均较少，T1时间点HR和BP较低（q=3.534，q=3.639，q=3.658，q=3.722，P＜0.05），SpO2和BIS值较高（q=3.968，q=4.113，q=5.337，q=5.472，P＜0.05）。与SP组比较，LP组和NP组术后恶心呕吐（c2=5.082，P＜0.05）及尿潴留发生率（c2=6.173，P＜0.05）较低，一次操作成功率较高（c2=3.893，P＜0.05）。结论局部浸润麻醉、神经阻滞及蛛网膜下腔阻滞麻醉方式联合静脉快通道麻醉均可安全应用于老年微创下肢骨科手术，但神经阻滞联合静脉快通道麻醉效果较好，术后并发症少，更适用于老年下肢微创骨科手术的患者。

英文摘要：

Objective To compare different anesthesia methods combined with fast track anesthesia in orthopedic minimally invasive lower limbs surgeries in the elderly.Methods A prospective study was performed in60cases who underwent arthroscopic knee surgery in the Third Hospital of Hebei Medical University from May2016to December2016.There were32males and28females,the range of age and body mass index were65to85years,and21to29kg/m2.All patients were randomly divided into3groups using a random number table:Local anesthesia combined with fast track anesthesia group(group LP,n=20),nerve block combined with fast track anesthesia group(group NP,n=20)and spinal anesthesia combined with fast track anesthesia group(group NP,n=20).LP group received local infiltration anesthesia on surgical site;NP group received iliac fascia clearance block combined with sciatic nerve block;SP group were spinal anesthesia.Before incision,they were used0.5-1mg/kg propofol via intravenous with infusion rate of0.06-0.1mg/kg/min and maintained the bispectral index value between50-60.BP,HR,SpO2,BIS,applications of analgesics,operation success rate,vascular active drugs and assisted ventilation,awakening time,dosage of propofol,postoperative complications and length of hospital stay were recorded.Results No adverse events occurred during operation.Compared to LP group,intraoperative auxiliary respiratory rate(c2=4.263,P<0.05),analgesia drug utility ratio(c2=3.392,P<0.05),dosage of propofol(q=4.983,q=5.284,P<0.05)of NP and SP group were significantly decreased,same as the awakening time(q=3.408,q=54.172,P<0.05),heart rates and blood pressure(q=3.534,q=3.639,q=3.658,q=3.722,P<0.05)at T1,while SpO2and BIS at T1were increased(q=3.968,q=4.113,q=5.337,q=5.472,P<0.05);Compared to SP group,incidence of nausea and vomiting(c2=5.082,P<0.05)and incidence of urinary retention(c2=6.173,P<0.05)was significantly lower in LP and NP group while operation success rate(c2=3.893,P<0.05)were increased.Conclusions Different anesthesia methods combined with fast track anesthesi