神经阻滞联合全麻在老年髋关节置换术中的麻醉效果及对患者应激反应的影响

Research on the Effect of Nerve Block Combined with General Anesthesia on the Anesthetic Effect and the Stress Response in Elderly Hip Replacement Patients

目的:分析神经阻滞联合全麻在老年髋关节置换术中的麻醉效果及对患者应激反应的影响。方法:选取德州市人民医院2017年6月—2019年6月收治的130例老年髋关节置换术患者,随机分为两组,对照组65例术中予以全麻,观察组65例予以腰丛-坐骨神经阻滞联合全麻,对比两组患者的麻醉效果、手术指标、镇痛效果及应激反应。结果:观察组的麻醉优良率是98.46%,高于对照组的89.23%,差异有统计学意义(P<0.05);观察组的下床活动时间、拔管时间及出院时间均比对照组短,差异有统计学意义(P<0.05);术后2 h、8 h、12 h、24 h及48 h时,观察组的疼痛视觉模拟评分(VAS)均比对照组低,差异有统计学意义(P<0.05);手术30 min、术毕时、术后1 h、术后1 d、术后2 d时,观察组的皮质醇及C反应蛋白水平比对照组低,且手术30 min时,观察组的去甲肾上腺素水平比对照组高,术毕时、术后1 h、术后1 d、术后2 d,观察组去甲肾上腺素水平比对照组低,差异有统计学意义(P<0.05)。结论:神经阻滞联合全麻有助于提升老年髋关节置换术患者的麻醉效果,改善其手术指标,提高镇痛效果,并降低应激反应。

Objective Analyze the effect of nerve block combined with general anesthesia on the anesthetic effect and the stress response in elderly hip replacement patients.Methods 130 cases of elderly hip replacement patients who treated in our hospital from June 2017 to June 2019 as the objects.They were randomly divided into two groups according to computer-generated number table method.Among them,65 cases in the control group were given general anesthesia and 65 cases in the observation group were given Lumbar plexus-sciatic nerve block combined with general anesthesia.The anesthetic effect,surgical index,analgesic effect and stress response were compared between the two groups.Results The excellent anesthetic rate in the observation group was 98.46%,which was higher than that of the 89.23%in the control group,with statistically significant(P<0.05).The out-of-bed activity time,extubation time and discharge time of the observation group were shorter than those in the control group,with statistically significant(P<0.05).At 2h,8h,12h,24h and 48h after surgery,the visual analogue scale(VAS)scores of the observation group were lower than those of the control group,with statistically significant(P<0.05).When the surgery is carried out to 30min,at the end of the operation,1 hour,1 day and 2 days after surgery,the levels of cortisol and C-reactive protein in the observation group were lower than those in the control group.When the surgery is carried out to 30min,the norepinephrine level in the observation group was higher than that in the control group.At the end of the operation,1 hour,1 day and 2 days after surgery,the norepinephrine levels in the observation group were lower than those in the control group,with statistically significant(P<0.05).Conclusion Nerve block combined with general anesthesia can help to improve the anesthetic effect in elderly hip replacement patients,which can improve their surgical indicators,improve the analgesic effect as well as reduce stress response.