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.
引文
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