腰丛-坐骨神经阻滞联合喉罩全麻对老年全髋关节置换术患者血流动力学和术后认知功能的影响

Effects of Lumbar Plexus Sciatic Nerve Block Combined with Laryngeal Mask General Anesthesia on Hemodynamics and Postoperative Cognitive Function in Elderly Patients Undergoing Total Hip Replacement

目的:探讨腰丛-坐骨神经阻滞联合喉罩全麻对老年全髋关节置换术患者血流动力学和术后认知功能的影响。方法:选取2017年6月~2019年4月期间我院收治的择期行全髋关节置换术的老年患者121例。采用随机数字表法分为A组(n=60,喉罩全麻)和B组(n=61,腰丛-坐骨神经阻滞联合喉罩全麻),比较两组患者围术期指标、血流动力学指标、简易智能状态量表(MMSE)评分及不良反应情况。结果:两组患者麻醉诱导后(T2)-术后1 h(T5)时间点心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))均呈先降低后升高趋势(P<0.05);B组T2~手术结束即刻(T4)时间点SpO_(2)、MAP、HR高于A组(P<0.05)。两组术后1 d、术后3 d、术后7 d MMSE评分均呈先降低后升高趋势,但B组MMSE评分高于A组(P<0.05)。两组术中出血量比较差异无统计学意义(P>0.05),B组麻醉维持时间长于A组,术后苏醒时间、呼吸功能恢复时间则短于A组(P<0.05)。两组不良反应发生率对比未见统计学差异(P>0.05)。结论:老年全髋关节置换术患者术中给予腰丛-坐骨神经阻滞联合喉罩全麻,可有效改善围术期指标,稳定患者血流动力学,减少术后认知功能损害。

Objective:To investigate the effect of lumbar plexus sciatic nerve block combined with laryngeal mask general anesthesia on hemodynamics and postoperative cognitive function in elderly patients undergoing total hip replacement.Methods:121 elderly patients from June 2017 to April 2019 were selected for total hip replacement.The patients were divided into group A(n=60,laryngeal mask general anesthesia)and group B(n=61,lumbar plexus sciatic nerve block combined with laryngeal mask general anesthesia)were randomly divided into two groups.The perioperative indexes,hemodynamics indexes,Simple intelligent state scale(MMSE)scores and adverse reactions of the two groups were compared.Results:The Heart rate(HR),mean arterial pressure(map),blood oxygen saturation(SpO_(2))of the two groups decreased first and then increased at after anesthesia induction(T2)-1 h after operation(T5)(P<0.05),and SpO_(2),MAP and HR of the group B were higher than those of the group A(P<0.05).The MMSE scores of the two groups decreased first and then increased on the first day,the third day and the seventh day,but the MMSE scores of group B were higher than those of group A(P<0.05).There was no significant difference in the amount of bleeding between the two groups(P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:The elderly patients with total hip arthroplasty who received lumbar plexus sciatic nerve block combined with laryngeal mask general anesthesia can effectively improve the perioperative indexes,stabilize the hemodynamics of patients,and reduce the postoperative cognitive impairment.