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

Application of ultrasound-guided lumbar and sacral plexus block combined with general anesthesia using laryngeal mask airway ventilation in elderly patients undergoing hip arthroplasty

目的观察超声引导下腰骶丛神经阻滞联合喉罩通气全身麻醉(全麻)在老年患者髋关节手术中的应用效果。方法单侧髋关节手术老年患者40例随机均分为超声引导下实施腰骶丛神经阻滞后行喉罩通气全麻组(NB组)和气管插管静吸复合麻醉组(GA组)。记录两组麻醉前(T0)、气管插管或置入喉罩即刻(T1)、手术切皮即刻(T2)、假体植入时(T3)、关闭切口时(T4)和拔管或取出喉罩时(T5)患者的MAP和HR。记录苏醒时间、拔管或取出喉罩时间以及术中舒芬太尼、肌肉松弛药和血管活性药物使用总量。结果与GA组相比,NB组T1、T2、T3、T5时的MAP和HR较低,舒芬太尼、肌肉松弛药、血管活性药物使用剂量较少,苏醒时间较快(P<0.05)。结论与气管插管静吸复合麻醉比较,超声引导下腰骶丛神经阻滞复合喉罩通气全麻能够为髋关节手术提供更完善的麻醉效果,维持循环稳定,苏醒质量高。

Objective To observe the clinical efficacy of ultrasound-guided lumbar and sacral plexus block combined with general anesthesia using laryngeal mask airway（LMA）ventilation in elderly patients undergoing hip arthroplasty.Methods Forty elderly patients scheduled for hip arthroplasty were equally randomized into two groups of NB（ultrasound guided lumbar and sacral plexus block combined with LMA ventilation general anesthesia）and GA（endotracheal intubation general anesthesia）.Heart rate（HR）,mean arterial pressure（MAP）were recorded before anesthesia（T0）and at the time points of tracheal intubation or LMA insertion（T1）,skin incision（T2）,prosthesis implantation（T3）,incision closure（T4）and extubation or LMA removal（T5）.The recovery time and extubation or LMA removal time were recorded.The total amounts of sufentanil,skeletal muscular relaxant and vasoactive agents used during operation were calculated.Results Compared with group GA,MAP and HR at T1,T2,T3 and T5 were lower,the total amounts of sufentanil,skeletal muscular relaxant and vasoactive agents were less,and recovery time from anesthesia was earlier in group NB（P〈0.05）.Conclusion Ultrasound-guided lumbar and sacral plexus block combined with LMA ventilation general anesthesia is effective in hip arthroplasty with stable circulation and shorter recovery time from anesthesia.