七氟醚联合腰骶丛神经阻滞在老年患者人工股骨头置换术中的应用

Application of sevoflurane inhalation combined with lumbosacral plexus block in elderly patients undergoing total hip replacement

目的比较七氟醚与丙泊酚分别联合腰骶丛阻滞用于老年患者人工股骨头置换术时血流动力学变化及术后并发症发生情况。方法选择择期接受单侧人工股骨头置换手术的老年（年龄≥60岁）患者60例，随机分为七氟醚组（S组）和丙泊酚组（P组），观察并记录诱导前后、切皮、假体植入中及手术结束各时点血流动力学变化，术毕呼之睁眼及拔除喉罩时间，记录患者苏醒期恶心呕吐、烦躁等不良反应发生情况，并且应用简易精神状态量表（minimental state examination，MMSE）评估记录患者术后认知功能障碍（postoperative cognitive dysfunction，POCD）等并发症发生情况。结果两组患者血压、心率较平稳，总体方差分析组间差异无统计学意义（P〉0．05）；但诱导前后血压变化的差值两组间比较差异有统计学意义（P〈0．05）；丙泊酚组诱导后及假体植入过程中血压变化较前一时点明显（P〈0．05）；术毕停药后，两组患者均苏醒迅速，拔除喉罩早；两组患者POCD发生情况：术后1d七氟醚组与丙泊酚组分别发生POCD5例（17％）和3例（10％），第3～7天患者认知功能均完全恢复至术前水平，两组比较差异无统计学意义（P〉0．05）。结论老年患者行单侧人工股骨头置换术使用七氟醚吸人与腰骶丛神经阻滞联合麻醉，术中血流动力学平稳，术毕苏醒迅速，并发症少，麻醉方法安全、有效。

Objective To explore the effects of combined sevoflurane inhalation and lumbosacral plexus nerve block in elderly patients receiving prosthesis implantation for total hip replacement. Methods Sixty elderly patients （ASA class I , II or III and all aged more than 60） with hip replacement were randomly assigned into the control group （group S） or the observation group （group P）, 30 patients in each group. During the operations, all patients were anaesthetized with lumbosacral plexus nerve block, plus sevoflurane inhalation for patients in group S or propofol intravenous infusion for patients in group P. The changes of hemodynamics and adverse effects were recorded. Neuropsychological testing was performed with minimental state examination （MMSE） prior to and the first week after the operation for the assessment of cognitive function. The incidence of postoperative cognitive dysfunction （POCD） was compared between groups. Results Regarding the preoperative vital signs including blood pressure, heart rhythm, no significant statistical difference was shown （P〉0.05） between both groups. Arterial blood pressures before and after induction anesthesia differed with statistical significance （P〈0.05）. POCD occurred in 5 patients in group S and 3 in group P without statistical significant difference （P 〉 0.05）. Conclusion The combination of sevoflurane inhalation and lumbosacral plexus block is safe and effective for elderly patients receiving prosthesis implantation.