高龄患者髋关节置换术后持续腰丛神经阻滞镇痛的应用观察

Clinical observation of post-operative lumbar plexus block in elderly patients undergoing total hip arthroplasty

目的观察腰丛神经阻滞用于老年全髋关节置换术患者的临床效果。方法择期拟在全身麻醉下行单侧全髋关节置换术老年患者70例,按随机数字表法将其分为对照组（A组）和腰丛神经阻滞组（B组）,每组35例。所有患者在腰硬联合麻醉下手术,手术步骤基本相同。手术结束后,B组连接电子镇痛输注泵,持续输注0.1%～0.15%罗哌卡因;A组予临时静脉镇痛。分别于术前（T0）、术后24 h（T1）及术后48 h（T2）时记录患者HR、MAP和SpO2;分别于术后6、12、24和48 h时行NRS疼痛评分。结果与T0时比较,A组T1、T4时MAP升高、HR增快（P〈0.05）,B组各时点MAP和HR差异无统计学意义（P〉0.05）;与A组比较,B组T1、T2时MAP和HR降低,SpO2差异无统计学意义（P〉0.05）。术后B组患者疼痛评分均明显低于A组,差异有统计学意义（P〈0.01）。结论连续腰丛神经阻滞用于老年全髋关节置换手术可降低患者对手术创伤的内分泌效应,使血流动力学更稳定,而且能够达到满意的镇痛效果,减少术后非甾体或阿片类镇痛药的用量。

Objective To observe the clinical efficacy of post-operative lumbar breadth block in elderly patients undergoing total hip arthroplasty.Methods A total of 70 case of ASA Ⅰ-Ⅱ patients scheduled for elective total hip arthroplasty under general anesthesia with lumbar plexus block were divided into two groups by randomized numerical table,with 35 patients in each group.The patients in group B received lumbar plexus block with 0.1%to 0.15%ropivacaine after operation and those in group A received intravenous analgesia.The patients were given patient controlled intravenous analgesia with sufentanil after surgery.The heart rate（HR）,mean arterial pressure（MAP） and oxygen saturation（SpO2） were recorded after admission to the operating room（T0） 24 hours after surgery（T1） and 48 hours after surgery（T2）.The NRS score was recorded 6,12,24 and 48 hours after the operation.Results Compared with T0,MAP and HR significantly increased at T1 and T2 in group A（P〈0.05）.No significant differences were found among time points in group B（P〈0.05）.Compared with group A,the MAP and HR decreased in group B（P〈0.05）.There was no significant difference in the SpO2 between group A and group B（P〉0.05）.The pain scores of B group were significant lower than that in A group,the difference was statistically signifiant（P〈0.01）.Conclusion Lumbar plexus block used in total hip arthroplasty can not noly reduce the endocrine effect of patients after surgert,better stabilizing the hemodynamics,but also can achieve a satisfactory analgesic effect,therefore reducing the dosage of opioid analgesics and NSAID after surgery.