[1]何金乾.超声引导下腰骶神经丛阻滞联合吸入麻醉在老年全髋关节置换术中的应用[J].新乡医学院学报,2018,35(9):799-803.[doi:10.7683/xxyxyxb.2018.09.012]
　HE Jin-qian.Application of lumbosacral plexus block combined with inhalation anesthesia under ultrasonic guidance in elderly patients undergoing total hip arthroplasty[J].Journal of Xinxiang Medical University,2018,35(9):799-803.[doi:10.7683/xxyxyxb.2018.09.012]
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超声引导下腰骶神经丛阻滞联合吸入麻醉在老年全髋关节置换术中的应用
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年9
页码:
799-803
栏目:
临床研究
出版日期:
2018-09-05

文章信息/Info

Title:
Application of lumbosacral plexus block combined with inhalation anesthesia under ultrasonic guidance in elderly patients undergoing total hip arthroplasty
作者:
何金乾
（南阳市第一人民医院麻醉科，河南　南阳　473000）
Author(s):
HE Jin-qian
（Department of Anesthesiology，the First People′s Hospital of Nanyang City，Nanyang 473000，Henan Province，China）
关键词:
全髋关节置换术; 超声引导; 腰骶神经丛阻滞; 吸入麻醉
Keywords:
total hip replacement; ultrasonic guidance; lumbosacral plexus block; inhalation anesthesia
分类号:
R614
DOI:
10.7683/xxyxyxb.2018.09.012
文献标志码:
A
摘要:
目的　探讨超声引导下腰骶神经丛阻滞联合吸入麻醉在老年全髋关节置换术中的应用效果。方法　选择2015年6月至2017年6月于南阳市第一人民医院行全髋关节置换术的90例老年患者为研究对象，根据麻醉方法将患者分为观察组和对照组，每组45例。对照组患者给予喉罩吸入麻醉，观察组患者采取超声引导下腰骶神经丛阻滞联合喉罩吸入麻醉。记录2组患者气管插管时（T0）、手术切皮时（T1）、假体植入时（T2）、切口缝合时（T3）、进入麻醉苏醒室后15 min（T4）、进入麻醉苏醒室后30 min（T5）及进入麻醉苏醒室后45 min（T6）的心率（HR）、平均动脉压（MAP）及脉搏血氧饱和度（SpO2）；2组患者分别于术后2、4、6 h采用视觉模拟评分法（VAS）进行疼痛评分；记录2组患者的术后拔管时间、下床活动时间、出院时间及不良反应；2组患者分别于手术前及手术1 d后进行简易智力状态检查量表（MMSE）评分和蒙特利尔认知评估量表（MoCA）评分。结果　T0、T1时2组患者HR、MAP、SpO2比较差异均无统计学意义（P>0.05）；对照组患者T2～T7时的HR、MAP高于T0时（P<0.05），观察组患者T3～T7时的HR低于T0时（P<0.05），T2～T7时观察组患者HR、MAP低于对照组（P<0.05），T0～T7时2组患者SpO2比较差异均无统计学意义（P>0.05）。术后2、4、6 h，观察组患者VAS评分低于对照组（P<0.05）。观察组患者拔管时间、下床活动时间及出院时间短于对照组（P<0.05）。2组患者术前MMSE、MoCA评分比较差异均无统计学意义（P>0.05）；对照组患者术后MMSE、MoCA评分低于术前（P<0.05），观察组患者手术前后MMSE、MoCA评分比较差异无统计学意义（P>0.05）。观察组患者术后MMSE、MoCA评分高于对照组（P<0.05）。观察组和对照组患者不良反应发生率分别为6.67%（3/45）、22.22%（10/45），观察组患者不良反应发生率低于对照组（χ2=4.406，P<0.05）。结论　超声引导下腰骶神经丛阻滞联合吸入麻醉能够显著减轻老年全髋关节置换术患者的疼痛，改善患者术后认知功能，促进患者恢复，且不良反应较少。
Abstract:
Objective　To investigate the effect of lumbosacral plexus block combined with inhalation anesthesia under ultrasonic guidance in elderly patients undergoing total hip arthroplasty.Methods　A total of 90 elderly patients undergoing total hip arthroplasty in the First People′s Hospital of Nanyang City from June 2015 to June 2017 were selected as subjects.The patients were divided into observation group and control group according to anesthesia method，45 cases in each group.The patients in the control group were given inhalation anesthesia by laryngeal mask，while the patients in the observation group were given ultrasound-guided lumbosacral plexus block combined with inhalation anesthesia by laryngeal mask.The heart rate （HR），average arterial pressure （MAP） and pulse oxygen saturation （SpO2） of the patients in the two groups were recorded at the time points of tracheal intubation （T0），surgical incision （T1），prosthesis implantation （T2），incision suture （T3），15 minutes after entering the anaesthetized room （T4），30 minutes after entering the anaesthetized room （T5） and 45 minutes after entering the anaesthetized room （T6）.The pain score of the patients in the two groups was evaluated by visual analogue scales （VAS） at the time points of 2，4 and 6 hours after operation.The postoperative extubation time，ambulation time，discharge time and adverse reactions of the patients in the two groups were recorded.The patients of the patients in the two groups were assessed with the simple mental state examination scale （MMSE） and the Montreal cognitive assessment scale （MoCA） before and one day after surgery.Results　There was no significant difference in HR，MAP and SpO2 between the two groups at T0 and T1 （P>0.05）.The HR and MAP at T2-T7 were higher than those at T0 in the control group （P<0.05）.The HR of the patients in the observation group at T3-T7 was lower than that at T0 （P<0.05）.The HR and MAP of the patients in the observation group were lower than those in the control group at T2-T7 （P<0.05）.There was no significant difference in SpO2 between the two groups at T0-T7 （P>0.05）.The VAS score of the patients in the observation group was lower than that in the control group at 2，4 and 6 hours after operation （P<0.05）.The extubation time，ambulation time and discharge time of the patients in the observation group were shorter than those in the control group （P<0.05）.There was no significant difference in preoperative MMSE score and MoCA score between the two groups （P>0.05）.The MMSE score and MoCA score after operation were lower than those before operation in the control group （P<0.05）.There was no significant difference in MMSE score and MoCA score in the observation group before and after operation （P>0.05）.The MMSE score and MoCA score in the observation group were higher than those in the control group （P<0.05）.The incidence of adverse reactions in the observation group and the control group was 6.67% （3/45） and 22.22% （10/45） respectively，the incidence of adverse reactions in the observation group was lower than that in the control group （χ2=4.406，P<0.05）.Conclusion　Ultrasound-guided lumbosacral plexus block combined with inhalation anesthesia can significantly reduce the pain，improve the postoperative cognitive function，promote the recovery of the elderly patients undergoing total hip replacement，and have less adverse reactions.

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更新日期/Last Update: 2018-09-05