超声引导下腰骶丛神经阻滞联合全麻在高龄患者髋关节置换术中的临床应用

安小凤; 方良勤; 吴丹

doi:10.16766/j.cnki.issn.1674-4152.001763

超声引导下腰骶丛神经阻滞联合全麻在高龄患者髋关节置换术中的临床应用

doi: 10.16766/j.cnki.issn.1674-4152.001763

1.
中国人民解放军陆军第七十二集团军医院麻醉科，浙江湖州 313000
2.
中国人民解放军陆军第七十二集团军医院骨科，浙江湖州 313000

基金项目:

浙江省医学会临床科研资金项目 2018ZYC-A78

详细信息

通讯作者:
安小凤, E-mail: bairunee@163.com

中图分类号: R687.4 R614
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出版历程
- 收稿日期: 2020-04-30
- 网络出版日期: 2022-02-19

Clinical application of ultrasound-guided low sacral plexus nerve block combined with general anesthesia in hip replacement for elderly patients

1.
Department of Anesthesia, Seventy-two Group Military Hospital, Huzhou, Zhejiang 313000, China

摘要

摘要: 目的观察超声引导下腰骶丛神经阻滞联合全麻应用于高龄患者髋关节置换术对患者术后临床疗效的影响。方法选择2018年1月—2020年1月中国人民解放军陆军第七十二集团军医院骨科收治的80例择期行全髋关节置换术的老年高龄患者纳入研究，随机数字表法分为观察组和对照组，每组40例，2组患者术式一致，观察组麻醉方式采用超声引导下腰骶丛神经阻滞联合全麻，对照组麻醉方式为全麻，麻醉过程中均采用喉罩通气，脑电图双频指数(BIS)保持在45~55，记录2组患者入室前(T0)、麻醉10 min(T1)、手术开始30 min(T2)、术后2 h(T3)的心率(HR)、平均动脉压(MAP)，记录术后6、12、24、36、48、72 h的VAS评分，记录患者术中输液量、舒芬太尼用量、手术时间、术中出血量、术后拔管时间及排气时间，并进行对比分析。结果观察组患者术中输液量、舒芬太尼用量、手术时间、术中出血量、术后拔管时间及排气时间显著低于对照组(均P＜0.05)；观察组T1、T2时刻的HR、MAP均低于对照组(均P＜0.05)；观察组患者术后6、12、24、36 h VAS评分低于对照组(均P＜0.05)。结论超声引导下腰骶丛神经阻滞联合全麻应用于高龄患者髋关节置换术时，与全麻相比，减少了术中阿片类镇痛药的用量，同时镇痛效果更佳，降低术中输液量和出血量，缩短手术时间、术后拔管时间及排气时间，患者麻醉满意度高。
- 腰丛神经阻滞 /
- 骶丛神经阻滞 /
- 老年 /
- 髋关节置换术 /
- 疗效
Abstract: Objective To observe the effect of ultrasound-guided sacral plexus block combined with general anesthesia on the postoperative clinical effect of hip replacement in elderly patients. Methods Total 80 elderly patients undergoing elective total hip replacement from January 2018 to January 2020 in our department were selected. They were randomly divided into experimental and control groups with 40 cases per group. The operation methods of the two groups were the same. The observation group was anesthetized by ultrasound-guided lumbosacral plexus block combined with general anesthesia, while the control group was anesthetized by general anesthesia. Laryngeal mask ventilation was used during anesthesia, and the bispectral index (BIS) of EEG was maintained at 45-55. The heart rate (HR) and mean arterial pressure (map) were recorded before entering the room (T0), 10 min after anesthesia (T1), 30 min after operation (T2) and 2 h after operation (T3), and 6, 12, 24, 36, 48 and 72 h after operation VAS scores were recorded, including intraoperative infusion volume, sufentanil dosage, operation time, intraoperative blood loss, postoperative extubation time and exhaust time. The data of two groups were compared and analysed. Results The intraoperative infusion volume, sufentanil dosage, operation time, intraoperative blood loss, postoperative extubation time, and exhaust time in the observation group were significantly lower than those in the control group (all P < 0.05). The HR and MAP of the observation group at T1 and T2 were lower than those of the control group (all P < 0.05). Vas scores at 6, 12, 24, and 36 h in the observation group were lower than those in the control group (all P < 0.05). Conclusion Compared with general anesthesia, ultrasound-guided lumbosacral plexus block combined with general anesthesia can reduce the dosage of opioid analgesics during the operation, and has better analgesic effect. It can reduce the amount of intraoperative infusion and blood loss, shorten the operation time, postoperative extubation time and exhaust time, and has high anesthesia satisfaction.
- Lumbar plexus nerve block /
- Sacral plexus block /
- Elderly patients /
- Hip replacement /
- The curative effect

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表 1 2组高龄全髋关节置换术患者一般资料比较(例)

组别	例数	性别		年龄(x±s，岁)	BMI(x±s)	ASA分级
组别	例数	男性	女性	年龄(x±s，岁)	BMI(x±s)	Ⅰ级	Ⅱ级
观察组	40	22	18	71.25±12.11	20.13±7.54	23	17
对照组	40	20	20	72.15±12.89	21.02±6.99	21	19
统计量		0.201^a		-0.322^b	-0.547^b	0.202^a
P值		0.654		0.748	0.586	0.653
注：^a为χ²值，^b为t值。

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表 2 2组高龄全髋关节置换术患者围手术期资料比较(x ±s)

组别	例数	术中输液量(mL)	舒芬太尼用量(mL)	手术时间(min)	术中出血量(mL)	术后拔管时间(min)	排气时间(h)
观察组	40	121.21±11.02	14.23±5.22	56.18±2.15	14.23±2.21	7.08±1.10	12.52±5.15
对照组	40	215.03±32.12	36.02±9.23	63.23±5.89	15.89±3.01	15.57±2.25	21.25±4.01
t值		-17.473	-12.996	-7.111	-2.812	-21.440	-8.459
P值		＜0.001	＜0.001	＜0.001	0.006	＜0.001	＜0.001

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表 3 2组高龄全髋关节置换术患者心率比较(x ±s，次)

组别	例数	T0	T1	T2	T3	F值	P值
观察组	40	72.43±8.88	61.87±6.55^a	60.50±6.89^a	60.37±4.64^a	35.536	＜0.001
对照组	40	74.66±5.56	66.54±6.87^a	65.45±4.78^a	61.23±5.64^a	21.114	＜0.001
t值		-1.346	-3.112	-3.733	-0.745
P值		0.182	0.003	＜0.001	0.458
注：与T0比较，^aP＜0.05。

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表 4 2组高龄全髋关节置换术患者MAP比较(x ±s，mm Hg)

组别	例数	T0	T1	T2	T3	F值	P值
观察组	40	105.33±10.56	90.87±8.54^a	88.65±7.55^a	87.43±10.67^a	25.221	＜0.001
对照组	40	104.66±7.74	96.56±7.87^a	94.87±6.80^a	89.34±6.98^a	18.441	＜0.001
t值		0.324	-3.099	-3.872	-0.947
P值		0.747	0.003	＜0.001	0.347
注：与T0比较，^aP＜0.05。1 mm Hg=0.133 kPa。

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表 5 2组高龄全髋关节置换术患者VAS比较(x ±s，分)

组别	例数	术后6 h	术后12 h	术后24 h	术后36 h	术后48 h	术后72 h	F值	P值
观察组	40	3.98±0.98	3.85±0.65	2.25±0.56^ab	1.72±0.23^ab	1.56±0.57^ab	1.45±0.27^ab	65.214	＜0.001
对照组	40	4.90±2.58	4.56±0.56	3.15±1.26^ab	2.99±1.36^ab	1.87±0.89^ab	1.56±0.25^ab	25.668	＜0.001
t值		-2.108	-5.234	-4.128	-5.823	-1.855	1.891
P值		0.038	＜0.001	＜0.001	＜0.001	0.067	0.062
注：与同组治疗前比较，^aP＜0.05；与术后12 h比较，^bP＜0.05。

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