超声引导下硬膜外阻滞在老年髋关节置换手术中的应用

Ultrasound-guided Epidural Blockade in Elderly Hip Replacement Surgery

目的:探讨超声引导下硬膜外阻滞在老年髋关节置换手术中的应用方法与效果。方法:2017年6月至2020年5月选择在本院进行髋关节置换手术的老年患者112例,根据随机数字表法把患者分为研究组与对照组,各56例。研究组给予超声引导下硬膜外阻滞,对照组给予传统的静脉持续镇痛。两组都给予全麻诱导与维持,记录镇痛效果与患者术后康复情况。结果:两组的性别、年龄、麻醉时间、手术时间与术中出血量等对比差异无统计学意义(P>0.05),研究组的术后住院时间显著短于对照组(P<0.05)。两组术后1 d、3 d、7 d的疼痛视觉模拟评分法(Visual Analogue Scale/Score,VAS)评分都低于术前1 d,观察组也都显著低于对照组,对比差异都有统计学意义(P<0.05)。研究组术后1 d、3 d、7 d的髋关节活动度都显著高于对照组(P<0.05)。研究组术后1 d、3 d、7 d的血清P物质(Substance P,SP)、前列腺素E2(Prostaglandin E2,PGE2)含量都高于术前1 d,观察组低于对照组,对比差异都有统计学意义(P<0.05)。结论:超声引导下硬膜外阻滞在老年髋关节置换手术中的应用能抑制血清SP、PGE2的释放,能缓解患者术后疼痛,促进髋关节功能的恢复,缩短患者的康复时间。

Objective:To explore the application method and effect of ultrasound-guided epidural block in elderly hip replacement surgery.Methods:From June 2017 to May 2020,112 cases of elderly patients who underwent hip replacement surgery in our hospital were selected as the research object,and the patients were divided into study group and control group of 56 cases in each groups accorded to the random number table method.The study group was given ultrasound-guided epidural block,and the control group was given traditional intravenous continuous analgesia.The two groups were given general anesthesia induction and maintenance,and the analgesic effects and patient's postoperative recovery were recorded.Results:There were no significant difference in gender,age,anesthesia time,operation time and intraoperative bleeding compared between the two groups(P>0.05).The postoperative hospital stay in the study group were significantly shorter than that in the control group(P<0.05).The visual analogue scale/score(VAS)scores of pain in the two groups at 1 d,3 d and 7 d after surgery were significantly lower than those at 1d before operation,and the study groups were lower than the control group(P<0.05).The hip joint mobility of the study group at 1 d,3 d and 7 d after surgery were significantly higher than that of the control group(P<0.05).The contents of Substance P(SP)and Prostaglandin E2(Prostaglandin E2,PGE2)in the two groups at 1 d,3 d and 7 d after surgery were significantly higher than those at 1 d before operation,and the study groups were lower than the control group(P<0.05).Conclusion:The application of ultrasound-guided epidural block in elderly hip replacement surgery can inhibit the release of serum SP and PGE2,can relieve postoperative pain,promote the recovery of hip function,and shorten the recovery time of patients.