超声引导下腰骶丛神经阻滞联合喉罩浅全麻在老年患者全髋关节置换术中的应用
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摘要
目的观察超声引导下腰骶丛神经阻滞联合喉罩浅全麻在老年患者全髋关节置换术中的麻醉和镇痛效果。方法将80例老年全髋关节置换术患者随机分为A、B 2组,各40例。A组采用腰硬联合麻醉,B组采用超声引导下腰骶丛神经阻滞联合浅全麻,2组术后均采用患者自控静脉镇痛(PCIA)。比较2组患者麻醉优良率。记录2组患者麻醉前(T0)、麻醉后30 min(T1)、麻醉后1 h(T2)和术毕即刻(T3)平均动脉压(MAP)、心输出量(CO)、心脏指数(CI)、心率(HR)。记录术后48 h PCIA总用量,术后3、6、12、24 h视觉模拟评分(VAS)以及术后不良反应发生率。结果 A组和B组患者麻醉优良率分别为92. 50%、90. 00%,2组比较差异无统计学意义(P> 0. 05);与T0比较,T1～T3时,2组患者MAP、HR升高,且A组高于B组(P <0. 05); T1,T2时,2组患者CO、CI明显高于T0(P <0. 05),但2组各时点比较差异无统计学意义(P> 0. 05);2组患者术后48 h PCIA总用量比较差异无统计学意义(P> 0. 05);与术后3 h相比,2组术后6、12、24、48 h VAS评分逐渐升高,差异有统计学意义(P <0. 05)。2组间以上时点比较VAS评分差异均无统计学意义(P> 0. 05); 2组术后不良反应发生率差异有统计学意义(P <0. 05)。结论与腰硬联合麻醉比较,超声引导下腰骶丛神经阻滞联合喉罩浅全麻使术中血流动力学更平稳,术后不良反应发生率更低,但麻醉效果和术后镇痛效果无明显优势。
Objective To observe the anesthetic and analgesic effects of ultrasound-guided lumbosacral plexus nerve block combined with laryngeal mask general anesthesia in elderly patients undergoing total hip joint replacement. Methods Eighty elderly patients of total hip joint replacement were randomly divided into group A and group B,with 40 cases in each group. Group A used combined spinal-epidural anesthesia,while group B used ultrasound-guided lumbosacral plexus nerve block combined with laryngeal mask general anesthesia,and all patients were treated with postoperative patient-controlled intravenous analgesia( PCIA) after surgery. The excellent rate of anesthesia was compared between the two groups. The average arterial pressure( MAP),cardiac output( CO),heart index( CI) and heart rate( HR) were recorded in two groups before anesthesia( T0),at 30 min after anesthesia( T1),1 h after anesthesia( T2) and immediate time after operation( T3). The total dosage of PCIA was recorded at 48 h after operation,the Visual Analogue Scale score( VAS)at 3,6,12,24 h after operation and the incidence of postoperative adverse reaction were recorded.Results The excellent rate of anesthesia in group A and group B was 92. 50% and 90. 00% respectively,there was no significant differences between two groups( P > 0. 05). Compared with T0,the MAP and HR were increased in the two groups at T1 to T3,and group A was higher than group B( P < 0. 05). Compared with T0,the CO and CI were significantly higher in the two groups at T1 and T2( P < 0. 05),but there were no statistically significant differences in above indicators between the two groups at different time points( P > 0. 05). There was no statistically significant difference in total PCIA dosage between the two groups at 48 h after surgery( P > 0. 05). Compared with the VAS scores at 3 h after surgery,the two groups had gradually increased VAS scores at 6,12,24,48 h after surgery,( P < 0. 05),but there was no significant difference in VAS score between the two groups at above time points( P > 0. 05). The incidence of postoperative adverse reactions in group A in group B was showed significant difference( P < 0. 05). Conclusion Compared with spinal-epidural anesthesia,ultrasound-guided lumbosacral plexus nerve block combined with laryngeal mask general anesthesia in total hip arthroplasty has more stable intraoperative hemodynamics,and lower incidence of postoperative adverse reactions. However,there is no obvious advantage in anesthetic and postoperative analgesia effect.
Objective To observe the anesthetic and analgesic effects of ultrasound-guided lumbosacral plexus nerve block combined with laryngeal mask general anesthesia in elderly patients undergoing total hip joint replacement. Methods Eighty elderly patients of total hip joint replacement were randomly divided into group A and group B,with 40 cases in each group. Group A used combined spinal-epidural anesthesia,while group B used ultrasound-guided lumbosacral plexus nerve block combined with laryngeal mask general anesthesia,and all patients were treated with postoperative patient-controlled intravenous analgesia( PCIA) after surgery. The excellent rate of anesthesia was compared between the two groups. The average arterial pressure( MAP),cardiac output( CO),heart index( CI) and heart rate( HR) were recorded in two groups before anesthesia( T0),at 30 min after anesthesia( T1),1 h after anesthesia( T2) and immediate time after operation( T3). The total dosage of PCIA was recorded at 48 h after operation,the Visual Analogue Scale score( VAS)at 3,6,12,24 h after operation and the incidence of postoperative adverse reaction were recorded.Results The excellent rate of anesthesia in group A and group B was 92. 50% and 90. 00% respectively,there was no significant differences between two groups( P > 0. 05). Compared with T0,the MAP and HR were increased in the two groups at T1 to T3,and group A was higher than group B( P < 0. 05). Compared with T0,the CO and CI were significantly higher in the two groups at T1 and T2( P < 0. 05),but there were no statistically significant differences in above indicators between the two groups at different time points( P > 0. 05). There was no statistically significant difference in total PCIA dosage between the two groups at 48 h after surgery( P > 0. 05). Compared with the VAS scores at 3 h after surgery,the two groups had gradually increased VAS scores at 6,12,24,48 h after surgery,( P < 0. 05),but there was no significant difference in VAS score between the two groups at above time points( P > 0. 05). The incidence of postoperative adverse reactions in group A in group B was showed significant difference( P < 0. 05). Conclusion Compared with spinal-epidural anesthesia,ultrasound-guided lumbosacral plexus nerve block combined with laryngeal mask general anesthesia in total hip arthroplasty has more stable intraoperative hemodynamics,and lower incidence of postoperative adverse reactions. However,there is no obvious advantage in anesthetic and postoperative analgesia effect.
引文
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[13]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.
[14]朱俊峰,冯兆明.超声引导下神经阻滞复合喉罩全身麻醉对老年髋关节置换手术麻醉和术后镇痛效应的影响[J].中华生物医学工程杂志,2015,21(6):524-527.
[15]赵达强,朱晓岚,许涛,等.超声引导下腰骶丛神经阻滞复合小剂量右美托咪定镇静用于老年患者髋部骨折手术的效果[J].上海医学,2014,37(8):657-661,633.
[16]朱小兵,吴论,彭学强,等.超声引导下腰骶丛神经阻滞联合鼻咽通气道对比联合喉罩在高龄患者股骨近端髓内钉内固定术中的应用[J].中华老年多器官疾病杂志,2017,16(9):654-658.
[17]程晓云,田卓敏,陈士寿,等.高龄患者髋关节置换术中超声引导下腰骶丛神经阻滞联合全麻的临床应用探讨[J].临床麻醉学杂志,2016,32(3):237-240.
[18]邱鲜凡.超声引导下腰骶丛神经阻滞联合小剂量丙泊酚在老年髋部骨折手术中的应用[J].福建医药杂志,2018,40(2):91-93.
[2]马靖华.罗哌卡因腰硬联合麻醉在老年髋关节置换术中的麻醉效果及安全性观察[J].中国临床研究,2015,28(4):483-485.
[3]汤洋,武茜,郑曼,等.超声引导下腰骶丛神经阻滞联合喉罩通气全身麻醉在老年患者髋关节手术中的应用[J].江苏医药,2017,43(13):946-948.
[4]郭晓丽,蒋敏,李海波,等.不同麻醉方法对老年患者髋关节置换术术后认知功能障碍的影响[J].现代生物医学进展,2016,16(26):5106-5108,5112.
[5]庞留成,赵峰,杨建生,等.小剂量不同浓度罗哌卡因麻醉在老年膝髋关节置换中的效果[J].中国组织工程研究,2017,21(15):2336-2341.
[6]许旭东,邹鲁,金娴冰,等.超声引导前路腰丛神经阻滞复合右美托咪定在老年髋部骨折手术中的应用研究[J].山西医药杂志,2016,45(16):1900-1902.
[7]曹雪芹,梅伟,陈明兵,等.老年患者全髋关节置换术的腰丛-骶丛神经阻滞麻醉方法[J].骨科,2016,7(6):425-428.
[8]王伟,姜晨轶,丁小萍.改良疼痛评估方法在全膝关节置换术后病人中的应用[J].护理研究,2017,31(11):1402-1403.
[9]赵婧.全程安全管理在老年髋关节置换术患者的应用[J].中国实用护理杂志,2016(z1):29-29.
[10]李雪娇,杨晶,孟晓敏,等.高龄患者全身麻醉术后发生并发症的危险因素分析[J].解放军护理杂志,2015,32(2):27-30.
[11]韩明,韩志强,王蕾.罗哌卡因用于腰硬联合麻醉及其扩散的研究进展[J].中国药物与临床,2016,16(4):527
[12]苏利伟.导管插入方向对连续硬膜外麻醉老年患者感觉异常发生率的影响研究[J].实用老年医学,2016,30(9):777-779.
[13]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.
[14]朱俊峰,冯兆明.超声引导下神经阻滞复合喉罩全身麻醉对老年髋关节置换手术麻醉和术后镇痛效应的影响[J].中华生物医学工程杂志,2015,21(6):524-527.
[15]赵达强,朱晓岚,许涛,等.超声引导下腰骶丛神经阻滞复合小剂量右美托咪定镇静用于老年患者髋部骨折手术的效果[J].上海医学,2014,37(8):657-661,633.
[16]朱小兵,吴论,彭学强,等.超声引导下腰骶丛神经阻滞联合鼻咽通气道对比联合喉罩在高龄患者股骨近端髓内钉内固定术中的应用[J].中华老年多器官疾病杂志,2017,16(9):654-658.
[17]程晓云,田卓敏,陈士寿,等.高龄患者髋关节置换术中超声引导下腰骶丛神经阻滞联合全麻的临床应用探讨[J].临床麻醉学杂志,2016,32(3):237-240.
[18]邱鲜凡.超声引导下腰骶丛神经阻滞联合小剂量丙泊酚在老年髋部骨折手术中的应用[J].福建医药杂志,2018,40(2):91-93.