超声引导下神经阻滞复合喉罩全身麻醉在老年人工股骨头置换术中的应用

Application of ultrasound-guided nerve block combined with laryngeal mask anesthesia in artifi-cial femoral head replacement for elder patients

目的 探究超声引导下神经阻滞复合喉罩全身麻醉在老年人工股骨头置换术中的应用效果.方法 选取2014年7月至2017年11月同煤集团总医院收治的不稳定型老年股骨颈骨折老年患者116例,依据随机数字表法分为实验组与对照组,每组58例.两组均择期行人工股骨头置换术,实验组行超声引导下神经阻滞复合喉罩全身麻醉,对照组行喉罩全身麻醉.统计两组术后谵妄（POD）、认知功能障碍（POCD）发生情况,比较两组麻醉前（T1）、喉罩置入时（T2）、切皮时（T3）、假体植入时（T4）、切口关闭时（T5）、喉罩取出时（T6）的心率（HR）、平均动脉压（MAP）水平及术后不同时间点（2、4、12、24、48 h）疼痛视觉模拟评分（VAS）.结果 T1、T5时点,实验组MAP、HR与对照组比较差异未见统计学意义（P〉0.05）.T2、T3、T4、T6时点,实验组MAP及HR均低于对照组,且实验组HR、MAP波动幅度小于对照组（P〈0.05）;术后2、4、12、24、48 h,实验组评分均低于对照组（P均〈0.05）;实验组POD发生率为3.45％、POCD发生率为6.90％,均低于对照组的15.52％、22.41％（P〈0.05）.结论 对行人工股骨头置换术的不稳定型股骨颈骨折老年患者予以超声引导下神经阻滞复合喉罩全身麻醉,血流动力学更加稳定,术后镇痛效果更为显著,且可一定程度减少POD、POCD的发生.

Objective To investigate the effects of ultrasound-guided nerve block combined with laryngeal mask anesthesia on elderly patients in artificial femoral head replacement. Methods A total of 116 elderly patients with unstable femoral neck fracture admitted in Datong Tongmei Group General Hos- pital from July 2014 to November 2017 were selected and were divided into study group and control group, with 58 cases in each group, according to random number table method. The patients in the two groups all underwent artificial femoral head replacement, while patients in study group were given ultra- sound-guided femoral nerve block compound with laryngeal mask anesthesia, and patients in control group were given general laryngeal mask anesthesia. The incidence of postoperative delirium （POD） and cognitive impairment （POCD） in the two groups were statistically analyzed. The heart rate （HR）, mean arterial pressure （MAP） before anesthesia （T1） and at the time of laryngeal mask insertion （T2）, skin incision （ T3 ）, prosthesis implantation （ T4 ）, incision closure （ T5 ） and laryngeal mask extraction （ T6 ） were compared between the two groups, and postoperative visual analogue scale （VAS） scores at different time points （2 hours, 4 hours, 12 hours, 24 hours and 48 hours after treatment） were compared between the two groups. Results There was insignificant difference in the MAP and HR levels between the study group and control group at T1 and T5 time point（P 〉0. 05）. At the time ofT2, T3, T4 and T6, the levels of HR and MAP in study group were lower than those in control group, and the amplitude of HR and MAP in study group were smaller than those in control group （P 〈 0. 05 ）. At 2 hours, 4 hours, 12 hours, 24 hours and 48 hours after operation, the VAS scores of study group group were lower than those of control group （P 〈0. 05 ）. The incidence of POD and POCD in study group were 3.45% and 6. 90%, respectively, which were lower than those of control group （15.52% and 22.41% ）, P 〈 0. 05. Conclusions Ultrasound-guided nerve block combined with laryngeal mask anesthesia in artificial femoral head replacement for elderly patients with unstable femoral neck fracture can get more stable hemodynamics, by which the postoperative analgesia is more effective. And it can reduce the occurrence of POD and POCD to a certain extent.