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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- 被引次数: 0
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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参考文献(17)

[1]	李信欣, 吕启圆, 李江圳, 等. 髋关节置换术后患者锻炼自我效能对院外功能锻炼依从性的影响研究[J]. 中国护理管理, 2019, 19(9): 1371-1375. doi: 10.3969/j.issn.1672-1756.2019.09.019
[2]	王君华, 刘淑霞, 陈月琴, 等. 高龄全髋关节置换患者术后肺部感染与血清炎性因子的变化研究[J]. 中华医院感染学杂志, 2019, 29(9): 1396-1399. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201909027.htm
[3]	陆小龙, 俞学锋, 胡四毛, 等. 超声引导下仰卧位腰丛阻滞与髂筋膜阻滞对高龄患者髋关节置换镇痛的比较: 单中心、随机、对照临床试验[J]. 中国组织工程研究, 2019, 23(8): 1149-1154. https://www.cnki.com.cn/Article/CJFDTOTAL-XDKF201908003.htm
[4]	刘娟, 丁继兵, 林家国. 微量泵持续给药硬膜外麻醉用于高龄患者全髋关节置换术的临床研究[J]. 重庆医学, 2017, 46(31): 4375-4377. doi: 10.3969/j.issn.1671-8348.2017.31.019
[5]	杨曙光, 陈堃, 陈超, 等. 仰卧位超声联合神经刺激器引导下腰骶丛神经阻滞[J]. 临床麻醉学杂志, 2019, 35(5): 507-508. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201905028.htm
[6]	严伟, 贺金晓, 潘守峰, 等. 侧卧位下髋关节直接前入路全髋关节置换术后短期疗效观察[J]. 中国微创外科杂志, 2020, 20(4): 335-340. doi: 10.3969/j.issn.1009-6604.2020.04.012
[7]	陈浩鹏, 谢辉, 傅维民, 等. 体质量指数对全髋关节置换后早期髋关节功能恢复影响的三维步态分析[J]. 中国组织工程研究, 2020, 24(18): 2842-2847. doi: 10.3969/j.issn.2095-4344.2667
[8]	石军, 刘明红, 薛敏, 等. 舒芬太尼静脉自控镇痛联合前路腰方肌阻滞对老年全髋关节置换患者术后镇痛和术后谵妄的影响[J]. 实用医学杂志, 2020, 36(3): 334-338. doi: 10.3969/j.issn.1006-5725.2020.03.012
[9]	刘磊, 沈文生, 凌义龙, 等. 老年髋关节置换术后汉防己甲素片镇痛的疗效[J]. 中国老年学杂志, 2019, 39(24): 5996-5998. doi: 10.3969/j.issn.1005-9202.2019.24.030
[10]	鲁义, 姚嘉茵, 龚楚链, 等. 老年髋关节置换术患者术后慢性疼痛的相关因素及其预测模型[J]. 临床麻醉学杂志, 2019, 35(12): 1197-1200. doi: 10.12089/jca.2019.12.013
[11]	李竞进, 陈自洋, 董洪权, 等. 右美托咪定注射液用于老年全麻髋关节置换术的临床研究[J]. 中国临床药理学杂志, 2019, 35(19): 2261-2264. https://www.cnki.com.cn/Article/CJFDTOTAL-GLYZ201919020.htm
[12]	孙启会, 罗永忠, 杨晓萍. 高龄患者人工髋关节置换术后急性精神障碍的原因分析及对策[J]. 中国矫形外科杂志, 2020, 28(11): 957-958. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS202011024.htm
[13]	秦洪猛, 王星, 司海超, 等. 麻醉方式对髋关节置换患者术后谵妄和镇痛效果的影响[J]. 中国矫形外科杂志, 2020, 28(11): 903-908. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS202011011.htm
[14]	任雪锋, 封婷, 陈练, 等. 超声引导下不同剂量右美托咪定联合罗哌卡因髂筋膜间隙阻滞对老年全髋关节置换术患者镇痛效果及应激水平的影响[J]. 中国老年学杂志, 2020, 40(10): 2100-2104. doi: 10.3969/j.issn.1005-9202.2020.10.027
[15]	高翔, 夏晓琼, 王亮, 等. 三种常见麻醉方式对全髋关节置换术的老年患者术后转归的影响[J]. 临床麻醉学杂志, 2018, 34(7): 669-672. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201807015.htm
[16]	陆小龙, 梅斌, 陈士寿, 等. 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的临床应用[J]. 临床麻醉学杂志, 2016, 32(3): 237-240. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201603008.htm
[17]	邓喜喜. 右美托咪定复合地佐辛镇痛治疗对中老年髋关节置换术后早期康复的影响[J]. 中国老年学杂志, 2018, 38(7): 1644-1646. doi: 10.3969/j.issn.1005-9202.2018.07.046