喉罩全麻联合髂筋膜间隙阻滞与腰硬联合麻醉用于老年髋部手术效果比较

Comparison of the effects of general laryngeal mask anesthesia combined with iliofascial block and lumbar epidural anesthesia in elderly patients undergoing hip surgery

目的:比较喉罩全麻联合髂筋膜间隙阻滞(GLB)与腰硬联合麻醉(CSEA)用于老年髋部手术的效果。方法:选择行择期髋部手术的老年患者100例,用随机数字表法将所有患者分为GLB组(n=50)与CSEA组(n=50)。比较两组患者麻醉前(T0)、麻醉后5 min(T1)、手术主要步骤进行时(T2)、术后8 h(T3)、术后12 h(T4)血氧饱和度、心率、血压变化;术后疼痛VAS评分,镇痛泵追加次数;术后24 h不良反应(恶心呕吐、头痛、尿潴留、发热、嗜睡、谵妄)发生情况以及患者满意度。结果:各时间点两组患者血氧饱和度无明显差异(P> 0. 05)。两组患者的心率、血压在T0无统计学差异(P> 0. 05),但GLB组在T1-T4时期心率、血压波动幅度明显低于CSEA组(P <0. 05),术后12 h时VAS评分及镇痛泵追加次数GLB组明显低于CSEA组(P <0. 01),GLB组术后24 h不良反应(恶心呕吐、头痛、尿潴留)发生率低于CSEA组(P <0. 05),而患者麻醉及镇痛满意度都显著高于CSEA组(P <0. 01)。结论:喉罩全麻联合髂筋膜间隙阻滞相比腰硬联合麻醉可有效改善老年患者髋部手术术中血流动力学波动,降低术后不良反应发生率,优化术后疼痛管理,提高患者的满意度。

AIM: To compare the effects of general laryngeal maskanesthesia combined with iliofascial block(GLB)and combined spinal-epidural anesthesia(CSEA) in the operation of elderly patients with hip surgery. METHODS: A total of 100 elderly hip patients undergoing elective surgery admitted from January 1, 2016 to December 31, 2016 in our hospital were randomly divided into GLB group and CSEA group, with 50 cases in each group. The changes of oxygen saturation, heart rate and blood pressure were compared between the two groups before anesthesia (T0), 5 min after anesthesia (T1), during the main procedure (T2), 8 h after operation (T3), 12 h after operation (T4). VAS score after operation and the times of analgesia pump were used to observe the pain; postoperative 24 h adverse reactions (nausea and vomiting, headache, urinary retention, fever, drowsiness, delirium) occurred and patient's satisfaction were also compared between the two groups. RESULTS: There was no significant difference in oxygen saturation between the two groups during the whole process (P>0.05). There was no significant difference in heart rate and blood pressure between two groups at T0 (P>0.05), but compared with GLB group, the fluctuation amplitude of heart rate, blood pressure were significantly lower than CSEA group during T1-T4(P<0.05), the postoperative VAS score and the times of analgesia pump used were significantly lower than CSEA group(P<0.01), postoperative 24 h adverse reactions were also lower than CSEA group(P<0.05), the patient's satisfaction in GLB group was higher than CSEA group(P<0.01). CONCLUSION: Compared with lumbar epidural anesthesia, the general laryngeal mask anesthesia combined with iliofascial block can effectively improve the hemodynamics fluctuation, reduce the incidence of postoperative adverse reactions, optimize postoperative pain management and improve patients ' satisfaction in the operation of elderly patients undergoing hip surgery.