超声引导下腰丛-坐骨神经阻滞复合右美托咪定持续泵注在老年髋关节置换术中的应用效果分析

Analysis of the Effect of Ultrasound guided Lumbar Plexus sciatic Nerve Block Combined with Continuous Pumping of Dexmedetomidine on Elderly Patients Undergoing Hip Replacement

目的探讨超声引导下腰丛-坐骨神经阻滞复合右美托咪定持续泵注在老年髋关节置换术中的应用效果。方法回顾性分析2017年1月至2019年3月南阳市骨科医院收治的分别采用超声引导下腰丛-坐骨神经阻滞复合右美托咪定持续泵注麻醉行髋关节置换术的51例老年患者(设为研究组)与右美托咪定持续泵注复合全身麻醉行髋关节置换术的51例老年患者(设为对照组)的病历资料,对比观察两组患者的麻醉时间,手术时间,输血量,右美托咪定使用量及入室后(T0)、麻醉诱导后即刻(T1)、麻醉诱导后5 min(T2)、麻醉诱导后30 min(T3)、术毕(T4)时的心率(HR)、平均动脉压(MAP)及血氧饱和度(SpO2),并采用视觉模拟评分法(visual analogue scale,VAS)评估患者术后2、4、8、12、24、48 h的疼痛程度。结果(1)两组患者麻醉时间、手术时间及输血量均无明显差异(P均>0.05),而研究组患者右美托咪定使用量明显少于对照组(t=9.612,P=0.000)。(2)T1、T2、T3、T4时,研究组患者HR及MAP均无明显变化(P均>0.05),而对照组患者HR及MAP均呈先降低后升高的趋势(F=12.560、4.643,P=0.000、0.001),且T1、T2、T3时研究组患者HR及MAP均明显高于对照组(HR:t=2.130、2.089、2.091,P=0.036、0.039、0.039;MAP:t=2.043、2.676、2.323,P=0.044、0.009、0.022),而T4时研究组患者HR及MAP均明显低于对照组(t=2.609、1.993,P=0.011、0.049);T1、T2、T3、T4时,两组患者SpO_2均无明显变化(P均>0.05),且各时间点两组患者SpO_2均无明显差异(P均>0.05)(3)术后2、4、8、12、24、48 h,两组患者VAS评分均呈先降低后升高再降低的趋势(F=85.860、32.650,P均=0.000),且术后2、4、8、12 h研究组患者VAS评分均明显低于对照组(t=14.380、12.540、11.490、15.960,P均=0.000),而术后24、48 h两组患者VAS评分无明显差异(P均>0.05)。结论超声引导下腰丛-坐骨神经阻滞复合右美托咪定持续泵注可有效维持老年髋关节置换术患者的麻醉药物用量,维持血流动力学稳定,降低疼痛程度,临床疗效更为显著。

Objective To explore the effect of ultrasound-guided lumbar plexus-sciatic nerve block combined with continuous pumping of dexmedetomidine on elderly patients undergoing hip replacement surgery.Methods Medical records of 51 elderly patients,who were admitted to Nanyang Orthopaedic Hospital from January 2017 to March 2019 and given ultrasound-guided lumbar plexus-sciatic nerve block combined with continuous pump of dexmedetomidine for hip replacement surgery(set as the study group)and medical records of 51 elderly patients who were admitted to the same hospital and given continuous pumping of dexmedetomidine combined with general anesthesia for hip replacement surgery(set as control group)were retrospectively analyzed.The anaesthesia time,surgery time,blood transfusion volume,usage amount of dexmedetomidine,and heart rate(HR),average arterial pressure(MAP)and blood oxygen saturation(SpO2)at time points after entering operation room(T0),immediately after anaesthesia induction(T1),5 min after anaesthesia induction(T2),30 min after anaesthesia induction(T3),and after surgery(T4)in the two groups were compared.Visual analogue scale(VAS)was used to assess the pain degree of patients at 2,4,8,12,24,48 h after surgery.Results(1)No significant difference was observed in anesthesia time,surgery time and blood transfusion volume between the two groups(all P>0.05)and usage amount of dexmedetomidine in the study group was significantly lower than that in the control group(t=9.612,P=0.000).(2)At T1,T2,T3 and T4,no significant change was observed in HR and MAP in the study group(all P>0.05),the HR and MAP in the control group showed a trend of decrease first followed by increase(F=12.560,4.643,P=0.000,0.001).The HR and MAP in the study group were significantly higher than those in the control group at T1,T2 and T3(HR:t=2.130,2.089,2.091,P=0.036,0.039,0.039;MAP:t=2.043,2.676,2.323,P=0.044,0.009,0.022),and HR and MAP in the study group were significantly lower than those in the control group at T4(t=2.609,1.993,P=0.011,0.049);no significant change was observed in the level of SpO2 within the two groups at T1,T2,T3 and T4(all P>0.05)and the comparison between the two groups(all P>0.05)showed no statistically significant difference.(3)At 2,4,8,12,24 and 48 h after the surgery,the VAS scores in the two groups showed a trend of decrease first followed by increase,and then decrease(F=85.860,32.650,all P=0.000)and the VAS scores in the study group were significantly lower than those in the control group at 2,4,8,and 12 h after the surgery(t=14.380,12.540,11.490,15.960,all P=0.000);no significant difference was observed in the VAS scores between the two groups at 24 and 48 h after the surgery(all P>0.05).Conclusion Ultrasound-guided lumbar plexus-sciatic nerve block combined with continuous pumping of dexmedetomidine can help to reduce the usage amount of anesthetic drugs for elderly patients undergoing hip replacement surgery,keep their haemodynamics stable and alleviate their pain,so it has good clinical effect.