全麻复合超声引导下髂筋膜阻滞对髋关节置换术患者血流动力学及应激激素的影响

Effect of General Anesthesia Combined with Ultrasound-guided Fascia Iliaca Block on Hemodynamics and Stress Hormone in Patients with Hip Replacement

目的:探讨全麻复合超声引导下髂筋膜阻滞对髋关节置换术患者血流动力学及应激激素的影响.方法:选取2017年10月-2019年3月于本院接受髋关节置换术治疗的患者共80例,按随机数字表法分为观察组与对照组,各40例.对照组采用常规全麻,观察组在对照组基础上联合超声引导下髂筋膜阻滞.比较两组手术开始前(T0)、切皮时(T1)、扩髓时(T2)、术毕时(T3)的血流动力学指标与应激激素水平,比较两组术后不良反应发生情况.结果:T1~3时,两组平均动脉压(mean arterial pressure,MAP)与心率(heart rate,HR)水平均高于T0,且观察组均低于对照组(P<0.05).T1~3时,两组皮质醇(cortisol,Cor)与促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)水平均高于T0,且观察组均低于对照组(P<0.05);两组术后不良反应发生率比较,差异无统计学意义(P>0.05).结论:全麻复合超声引导下髂筋膜阻滞在髋关节置换术中的应用效果理想,有利于维持患者血流动力学稳定,减轻应激反应,且安全性较高.

Objective:To investigate the application effect of general anesthesia combined with ultrasound-guided fascia iliaca block on hemodynamics and stress hormone in patients with hip replacement.Method:A total of 80 patients treated with hip replacement in our hospital from October 2017 to March 2019 were selected.They were divided into observation group and control group according to the random number table method,with 40 patients in each group.The control group was given general anesthesia,and the observation group was given ultrasound-guided fascia iliaca block on the basis of the control group.Before surgery(T0),at the time of skin incision(T1),at the time of reaming(T2)and at the end of surgery(T3),the hemodynamic indexes and stress hormone were compared between the two groups.The occurrence of postoperative adverse reactions was compared between the two groups.Result:At T1-3,mean arterial pressure(MAP)and heart rate(HR)of the two groups were higher than those at T0,and those of the observation group were lower than those of the control group(P<0.05).At T1-3,the levels of cortisol(Cor)and adrenocorticotropic hormone(ACTH)of the two groups were higher than those at T0,and those of the observation group were lower than those of the control group(P<0.05).There was no statistically significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion:General anesthesia combined with ultrasound-guided fascia iliaca block in hip replacement has ideal application effect,it can maintain the stability of hemodynamics,reduce stress response,and have higher safety.