超声引导下腰骶丛联合神经阻滞与硬膜外麻醉在高龄髋关节置换术患者中的应用效果

Application effects of ultrasound-guided lumbosacral plexus block and epidural anesthesia in elderly patients with hip replacement

目的比较超声引导下腰骶丛联合神经阻滞与硬膜外麻醉在高龄髋关节置换术患者中的应用效果。方法将200例高龄髋关节置换术患者根据电脑随机分配方式分为对照组与观察组,各100例。对照组采用硬膜外麻醉,观察组应用超声引导下腰骶丛联合神经阻滞。比较两组的不良反应发生情况、血流动力学指标、术后认知功能障碍发生情况、VAS评分。结果观察组的不良反应总发生率低于对照组(P<0.05)。T3时,两组的SBP、DBP、HR均高于T1、T2时,且T1时高于T2时(P<0.05);T1、T2、T3时,观察组的SBP、DBP、HR均高于对照组(P<0.05)。观察组的术后认知功能障碍发生率低于对照组(P<0.05)。术后2、4、10、24 h,观察组的VAS评分均低于对照组(P<0.05)。结论超声引导下腰骶丛联合神经阻滞应用于高龄髋关节置换术患者,可取得显著的麻醉效果,具有较高的安全性,对患者血流动力学影响较小,值得临床推广应用。

Objective To compare the application effect of ultrasound-guided lumbosacral plexus block and epidural anesthesia in elderly patients with hip replacement.Methods A total of 200 elderly patients with hip replacement were divided into control group and observation group according to the computer random distribution,with 100 cases in each group.The control group was given epidural anesthesia,and the observation group was given ultrasound-guided lumbosacral plexus block.The incidence of adverse reactions,hemodynamic indexes,postoperative cognitive dysfunction and VAS score were compared between the two groups.Results The total incidence of adverse reactions in the observation group was lower than that in the control group(P<0.05).At T3,SBP,DBP and HR of the two groups were higher than those at T1 and T2,and those at T1 were higher than at T2(P<0.05);at T1,T2 and T3,SBP,DBP and HR of the observation group were higher than those of the control group(P<0.05).The incidence of postoperative cognitive dysfunction in the observation group was lower than that in the control group(P<0.05).At 2,4,10,24 h after operation,the VAS score of the observation group were lower than those of the control group(P<0.05).Conclusion The ultrasound-guided lumbosacral plexus block in elderly patients with hip replacement can achieve significant anesthetic effect,with high safety and less impact on hemodynamics of patients,which is worthy of clinical promotion and application.