超声引导下行髂筋膜联合腰骶丛神经阻滞和全身麻醉在老年患者髋关节置换术中的对比研究

Comparison of ultrasound-guided iliac fascia block combined with lumbosacral plexus block versus general anesthesia in the elderly undergoing hip arthroplasty

目的对比超声引导下行髂筋膜联合腰骶丛神经阻滞和全身麻醉在老年患者髋关节置换术中的效果及安全性。方法选取2017年10月至2018年10月期间麻城市人民医院收治的行髋关节置换术的老年患者90例,按随机数表法分为观察组和对照组,每组45例。对照组采用全身麻醉,观察组采用髂筋膜联合腰骶丛神经阻滞,术后均随访30d。对比2组患者术中舒芬太尼用量,术后24h静脉自控镇痛(PCA)药物用量,下床活动时间,出院时间,术后4、12、24h的视觉模拟量表(VAS)评分,围手术期血流动力学,认知功能,术后30d并发症等。采用SPSS17.0软件进行数据处理。结果观察组术中舒芬太尼用量[(12.39±2.44)和(38.02±5.28)μg]、术后24hPCA用量[(58.34±3.59)和(81.13±4.25)ml]、下床活动时间[(4.16±0.81)和(5.34±1.15)d]及出院时间[(7.29±0.76)和(8.35±0.96)d]均显著少于对照组(P<0.01),而简易精神状态评定量表(MMSE)各项评分均显著高于对照组。观察组患者术后4h[(0.83±0.15)和(3.34±0.61)]、12h[(1..52±0.31)和(3.31±0.54)]、24h[(1.76±0.35)和(3.15±0.62)]的VAS评分均显著低于对照组(P<0.05)。观察组患者在麻醉完成后10min、手术开始时及手术结束时的平均动脉压(MAP)和心率(HR)均显著高于对照组(P<0.05)。术后随访30d,2组患者均未出现死亡,观察组患者并发症发生率显著低于对照组(4.44%和31.11%,P<0.05)。结论超声引导下行髂筋膜联合腰骶丛神经阻滞可应用于老年患者髋关节置换术,麻醉效果较好,对患者血流动力学及认知功能的影响较小,且安全性较高。

Objective To compare the clinical efficacy and safety of ultrasound-guided iliac fascia block combined with lumbosacral plexus block and general anesthesia in hip arthroplasty in elderly patients.Methods A total of 90 elderly patients undergoing hip arthroplasty in Macheng People′s Hospital from October 2017 to October 2018 were enrolled in this study,and randomly divided into observation group and the control group,with 45 cases in each group.General anesthesia was used in the patients of control group,while iliac fascia combined with lumbosacral plexus block was given to those in observation group.Both groups were followed up for 30 d post-operatively.The amount of intra-operative sufentanil,amount of drug in intravenous self-controlled pain (PCA),time of getting out of bed,time of discharge,scores of visual analogue scale (VAS) at 4,12 and 24 h after operation,peri-operative hemodynamic parameters,cognitive function,and incidence of complications in 30 d after operation were compared between the 2 groups.SPSS statistics 17.0 was used for data analysis.Results The observation group had less intra-operative sufentanil dosage [(12.39±2.44) vs (38.02±5.28)μg],lower drug amount in PCA in postoperative 24 h [(58.34±3.59) vs (81.13±4.25)ml],shorter time of getting out of bed [(4.16±0.81) vs (5.34±1.15)d] and discharge time [(7.29±0.76) vs (8.35±0.96)d] when compared with the control group (all P <0.01).But all the scores of mini-mental state examination (MMSE) were significantly higher in the former than the latter group.But the trends in VAS scores were opposite [4 h:(0.83±0.15) vs (3.34±0.61);12 h:(1.52±0.31) vs ( 3.31±0.54 );2.4 h:(1.76±0.35) vs (3.15±0.62),all P <0.05].The mean arterial pressure (MAP) and heart rate (HR) in the observation group were significantly higher than those of the control group at 10 min after the completion of anesthesia,at the beginning and at the end of operation ( P <0.05).After 30 d of follow-up,no death occurred in the 2 groups,and the incidence of complications was significantly lower in the observation group than the control group (4.44% vs 31.11%,P <0.05).Conclusion Ultrasonic-guided iliac fascia block combined with lumbosacral plexus block can be applied in hip arthroplasty for elderly patients with high safety,good anesthesia effectiveness,and less impact on the hemodynamics and cognitive function.