B超引导下腰丛复合坐骨神经阻滞麻醉对老年髋关节置换术患者血流动力学及应激反应的影响

Effects of lumbar plexus and sciatic nerve block anesthesia guided by B-mode ultrasound on hemodynamics and stress response in elderly hip replacement patients

目的探讨B超引导下腰丛复合坐骨神经阻滞(LPSNB)麻醉在老年髋关节置换术中的应用。方法选取2018年1月至2020年5月收治的48例择期行髋关节置换术患者作为研究对象,以随机数字表法将其分为对照组和观察组,每组24例。对照组予以气管插管全麻,观察组予以超声引导下LPSNB,观察不同时间点患者血流动力学指标、应激指标及疼痛程度。结果T0时,两组MAP、HR、SpO2无显著差异(P>0.05);T1、T2、T3、T4时,观察组MAP、HR、SpO2均高于对照组(P<0.05)。T0时,两组Cor、GLU水平无显著差异(P>0.05);T1、T2、T3、T4时,观察组Cor、GLU水平均低于对照组(P<0.05)。术后2、8、12 h,观察组静息、运动时VAS评分均低于对照组(P<0.05);术后24 h,两组静息、运动时VAS评分无显著差异(P>0.05)。结论B超引导下LPSNB能维持老年髋关节置换术患者血流动力学稳定,减轻机体应激反应,且术后镇痛效果较好。

Objective To explore the application of lumbar plexus and sciatic nerve block(LPSNB)anesthesia guided by B-mode ultrasound in elderly hip replacement surgery.Methods A total of 48 patients admitted for elective hip replacement from January 2018 to May 2020 were selected as the study objects,and they were divided into control group and observation group by random number table method,with 24 cases in each group.The control group received endotracheal intubation under general anesthesia,while the observation group received LPSNB guided by B-mode ultrasound.The hemodynamic indexes,stress indexes and pain degree of the patients at different time points were observed.Results At T0,there were no significant differences in MAP,HR and SpO2 between the two groups(P>0.05);at T1,T2,T3 and T4,MAP,HR and SpO2 of the observation group were all higher than those of the control group(P<0.05).At T0,there were no significant differences in Cor and GLU levels between the two groups(P>0.05);at T1,T2,T3 and T4,the levels of Cor and GLU in the observation group were lower than those in the control group(P<0.05).At 2,8,12 h after operation,the VAS scores of the observation group at rest and exercise were lower than those of the control group(P<0.05);at 24 h after operation,there were no significant differences between the two groups in the VAS score at rest and exercise(P>0.05).Conclusion LPSNB guided by B-mode ultrasound can maintain the hemodynamic stability of elderly patients undergoing hip replacement,reduce the stress response of the body,and have good postoperative analgesic effect.