超声引导下髂筋膜间隙阻滞麻醉结合喉罩下全麻对老年髋关节置换患者镇痛药物使用量及认知功能的影响

Effects of ultrasound-guided fascia iliaca compartment block anesthesia combined with general anesthesia under laryngeal mask on analgesic dosage and cognitive function in elderly patients undergoing hip replacement

目的分析超声引导下髂筋膜间隙阻滞(FICB)麻醉结合喉罩下全麻对老年髋关节置换患者镇痛药物使用量及认知功能的影响。方法选择2018年10月至2019年10月期间于本院进行髋关节置换术的老年患者76例,按抽签法随机将患者分为对照组(n=38)和联合组(n=38)。对照组给予喉罩下全麻治疗,联合组给予超声引导下FICB麻醉结合喉罩下全麻治疗,记录两组镇痛药物使用量,术后情况,术后2 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)时患者静息视觉模拟量表(VAS)评分和运动VAS评分以及术后1 d、3 d、5 d以及7 d时简易智力状态量表(MMSE)评分,并记录不良反应发生。结果联合组术中丙泊酚、舒芬太尼使用量以及术后自控泵镇痛药物用量明显少于对照组[(191.46±24.03)mg比(347.81±36.58)mg、(12.83±1.65)μg比(60.69±11.17)μg、(55.19±6.48)ml比(79.40±8.36)ml,均P<0.05];联合组人工气道拔除时间明显短于对照组[(21.98±3.86)min比(35.49±7.01)min](P<0.05),第一次补救镇痛时间明显长于对照组[(668.31±85.43)min比(480.95±78.79)min](P<0.05),补救镇痛使用次数以及血管活性药物使用次数明显少于对照组[(0.69±0.11)次比(1.34±0.25)次、(1.26±0.24)次比(2.72±0.50)次,均P<0.05];联合组患者术后T1~T4时静息VAS评分明显低于对照组[(2.04±0.33)分比(3.90±0.62)分、(2.19±0.37)分(3.91±0.54)分比、(2.33±0.41)分比(3.45±0.51)分、(2.21±0.39)分比(3.08±0.46)分,均P<0.05],术后T1~T5时运动VAS评分明显低于对照组[(2.87±0.42)分比(5.21±0.93)分、(2.94±0.49)分比(4.73±0.86)分、(2.88±0.45)分比(4.69±0.72)分、(2.45±0.36)分比(4.21±0.65)分、(2.90±0.44)分比(4.56±0.48)分,均P<0.05];联合组患者术后1、3、5、7 d时MMSE评分明显高于对照组[(26.03±1.67)分比(25.17±1.81)分、(25.61±1.33)分比(24.04±1.29)分、(26.05±1.01)分比(24.48±1.07)分、(26.92±1.18)分比(25.29±1.53)分,均P<0.05];两组患者呼吸抑制、恶心呕吐、咽喉痛等不良反应发生率比较,差异无统计学意义(P>0.05)。结论超声引导下FICB麻醉结合喉罩下全麻应用于老年髋关节置换患者,可有效减少镇痛药物使用量,改善患者术后情况,取得更加良好的镇痛效果,同时还可以保护患者认知功能。

Objective To analyze the effects of ultrasound-guided fascia iliaca compartment block(FICB)anesthesia combined with general anesthesia under laryngeal mask on analgesic dosage and cognitive function in elderly patients undergoing hip replacement.Methods A total of 76 elderly patients who underwent hip replacement at our hospital from October,2018 to October,2019 were selected and randomly divided into a control group(n=38)and a combined group(n=38)according to the lottery method.The control group took general anesthesia under laryngeal mask,and the combined group took FICB anesthesia under ultrasound guidance and general anesthesia under laryngeal mask.The analgesic dosages,postoperative conditions,resting visual analogue scale(VAS)scores and exercise VAS scores 2(T1),6(T2),12(T3),24(T4),and 48 h(T5)after surgery,and mini-mental state examination(MMSE)scores 1,3,5,and 7 d after surgery were recorded in the two groups.The incidences of adverse reactions were recorded.Results The dosages of propofol and sufentanil during surgery and self-controlled pump analgesic dosage after surgery were significantly less in the combined group than in the control group[(191.46±24.03)mg vs.(347.81±36.58)mg,(12.83±1.65)μg vs.(60.69±11.17)μg,and(55.19±6.48)ml vs.(79.40±8.36)ml;all P<0.05].The artificial airway removal time was significantly shorter,the first remedial analgesia time was significantly longer,and the application frequencies of remedial analgesic and vasoactive drugs were significantly lower in combined group than that in control group[(21.98±3.86)min vs.(35.49±7.01)min,(668.31±85.43)min vs.(480.95±78.79)min,(0.69±0.11)times vs.(1.34±0.25)times,and(1.26±0.24)times vs.(2.72±0.50)times;all P<0.05].The resting VAS scores at T1,T2,T3,and T4 and the exercise VAS scores at T1,T2,T3,T4,and T5 were significantly lower in the combined group than in the control group[(2.04±0.33)vs.(3.90±0.62),(2.19±0.37)vs.(3.91±0.54),(2.33±0.41)vs.(3.45±0.51),(2.21±0.39)vs.(3.08±0.46),(2.87±0.42)vs.(5.21±0.93),(2.94±0.49)vs.(4.73±0.86),(2.88±0.45)vs.(4.69±0.72),(2.45±0.36)vs.(4.21±0.65),and(2.90±0.44)vs.(4.56±0.48);all P<0.05].The MMSE scores 1,3,5,and 7 d after surgery were significantly higher in the combined group than in the control group[(26.03±1.67)vs.(25.17±1.81),(25.61±1.33)vs.(24.04±1.29),(26.05±1.01)vs.(24.48±1.07),and(26.92±1.18)vs.(25.29±1.53);all P<0.05].There were no statistical differences in the incidences respiratory depression,nausea and vomiting,and sore throat between the two group(P>0.05).Conclusions Ultrasound-guided FICB anesthesia combined with general anesthesia under laryngeal mask for elderly patients undergoing hip replacement can effectively reduce the analgesic dosages,improve the patients postoperative conditions,and achieve better analgesic effects,and also protect the patients'cognitive function.