腰丛联合坐骨神经阻滞麻醉对全膝关节置换术患者的血流动力学及应激状况的影响

Effect of lumbar plexus combined with sciatic nerve block anesthesia on hemodynamics and stress state of patients undergoing total knee arthroplasty

目的研究腰丛联合坐骨神经阻滞麻醉对全膝关节置换术患者的血流动力学及应激状况的影响。方法选择2017年2月至2018年2月在中国人民解放军空军军医大学第二附属医院治疗的90例全膝关节置换术患者作为研究对象,采用随机数表法将患者分为观察组和对照组,每组45例。对照组使用腰硬联合麻醉,观察组采用腰丛联合坐骨神经阻滞麻醉。比较两组患者的麻醉效果,以及术前(T0)、麻醉后10 min(T1)、拔管前15 min(T2)、拔管后15 min(T3)时的收缩压(SBP)、心率(HR)、皮质醇(Cor)、去甲肾上腺素(Ne)水平的变化和不良反应发生情况。结果观察组患者的麻醉优良率为97.78%,明显高于对照组的73.33%,差异有统计学意义(P<0.05);两组患者T0时的HR、SBP水平比较差异均无统计学意义(P>0.05);观察组患者HR在T1、T2、T3时[(80.64±3.17)次/min、(81.79±4.20)次/min、(91.24±6.47)次/min]明显高于对照组[(62.29±5.67)次/min、(61.99±5.34)次/min、(86.51±11.27)次/min],差异均有统计学意义(P<0.05);观察组患者SBP水平在T1、T2时[(137.74±8.01)mmHg、(138.61±9.52)mmHg]明显高于对照组[(103.78±10.94)mmHg、(111.79±7.41)mmHg],T3时为(141.89±5.36)mmHg,明显低于对照组的(168.85±6.25)mmHg,差异均有统计学意义(P<0.05);两组患者麻醉前的应激反应相关指标水平比较差异均无统计学意义(P>0.05);术后即刻,两组患者的Cor、Ne水平均明显下降,观察组患者的Cor、Ne水平分别为(86.54±24.53)ng/mL、(411.53±63.47)pg/mL,明显低于对照组的(127.34±25.74)ng/mL、(468.24±62.64)pg/mL,差异有统计学意义(P<0.05);观察组患者的不良反应总发生率为8.89%,明显低于对照组的37.78%,差异有统计学意义(P<0.05)。结论全膝关节置换术患者术中采用腰丛联合坐骨神经阻滞麻醉可有效改善患者的血流动力学及应激状况。

Objective To study the effect of lumbar plexus combined with sciatic nerve block anesthesia on hemodynamics and stress in patients undergoing total knee arthroplasty.Methods A total of 90 total knee replacement patients,who admitted to the Second Affiliated Hospital of Air Force Military Medical University of Chinese PLA from February 2017 to February 2018,were selected and divided into the observation group and control group according to random number table method,with 45 cases in each group.The control group was given combined spinal epidural anesthesia,and the observation group was given combined spinal plexus and sciatic nerve block anesthesia.The effects of anesthesia,changes of systolic blood pressure(SBP),heart rate(HR),cortisol(Cor),norepinephrine(Ne)and adverse reactions were compared between the two groups before operation(T0),10 minutes after anesthesia(T1),15 minutes before extubation(T2)and 15 minutes after extubation(T3).Results The effective rate of anesthesia in the observation group was 97.78%,which was significantly higher than 73.33%in the control group(P<0.05);there was no significant difference in HR and SBP at T0 between the two groups(P>0.05);the HR at T1,T2 and T3in the observation group were(80.64±3.17)times/min,(81.79±4.20)times/min,(91.24±6.47)times/min,respectively,which were significantly higher than corresponding(62.29±5.67)times/min,(61.99±5.34)times/min,(86.51±11.27)times/min in the control group(all P<0.05);the levels of SBP in T1 and T2 in the observation group were(137.74±8.01)mmHg,(138.61±9.52)mmHg,respectively,which were significantly higher than corresponding(103.78±10.94)mmHg and(111.79±7.41)mmHg in the control group,and in T3 was(141.89±5.36)mmHg,which was significantly lower than(168.85±6.25)mmHg in the control group(all P<0.05);there was no significant difference in the level of stress response before anesthesia between the two groups(P>0.05);after surgery,the levels of Cor and Ne were immediately significantly decreased in both groups,and the levels of Cor and Ne in the observation group were(86.54±24.53)ng/mL and(411.53±63.47)pg/mL,which were significantly lower than corresponding(127.34±25.74)ng/mL and(468.24±62.64)pg/mL in the control group(P<0.05);the total incidence of adverse reactions in the observation group was 8.89%,which was significantly lower than 37.78%in the control group(P<0.05).Conclusion In total knee arthroplasty,lumbar plexus combined with sciatic nerve block anesthesia can effectively improve the hemodynamics and stress of patients.