喉罩保留自主呼吸全麻联合超声引导下神经阻滞在老年患者髋关节置换术麻醉中的应用

Application of Laryngeal Mask Reserved Spontaneous Breathing General Anesthesia Combined with Ultrasound-Guided Nerve Block in Anesthesia for Hip Replacement in Elderly Patients

目的探讨喉罩保留自主呼吸全麻联合超声引导下神经阻滞在老年患者髋关节置换术麻醉中的应用效果。方法回顾性收集2019年4月至2020年5月于郑州人民医院接受髋关节置换术的95例老年患者的临床资料,按照麻醉方式分为两组,采用喉罩全麻实施麻醉为对照组(47例),采用喉罩保留自主呼吸全麻联合超声引导下神经阻滞实施麻醉为观察组(48例)。比较两组术后苏醒时间、瑞芬太尼用量、恢复室停留时间,麻醉前(T_(0))、喉罩使用时(T_(1))、切皮时(T_(2))、摘除喉罩时(T_(3))血流动力学[心率(HR)、平均动脉压(MAP)],术后2、8、12、24 h视觉模拟评分量表(VAS)评分及不良反应发生率。结果观察组术后苏醒时间、恢复室停留时间均短于对照组,瑞芬太尼用量少于对照组(P<0.05)。两组T_(2)、T_(3)时刻MAP、HR水平均高于T_(0)时刻,两组T_(3)时刻MAP、HR水平均高于T_(1)时刻(P<0.05),T_(2)、T_(3)时刻观察组MAP、HR水平均低于对照组(P<0.05)。观察组术后2、8、12、24 h VAS评分均低于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论将喉罩保留自主呼吸全麻联合超声引导下神经阻滞应用于髋关节置换术老年患者中可有效缩短术后苏醒、恢复室停留时间,减少麻醉药物用量,降低术中MAP、HR波动幅度,减轻术后疼痛。

Objective To explore the application effect of laryngeal mask reserved spontaneous breathing general anesthesia combined with ultrasound-guided nerve block in anesthesia for hip replacement in elderly patients.Methods The clinical data of 95 elderly patients undergoing hip arthroplasty in Zhengzhou People’s Hospital from April 2019 to May 2020 were collected retrospectively and divided into two groups according to the anesthesia method.Forty-seven patients who underwent general anesthesia with laryngeal mask were selected as control group,while forty-eight patients who underwent general anesthesia with laryngeal mask reserved spontaneous breathing combined with ultrasound-guided nerve block anesthesia were selected as observation group.Postoperative wake-up time,dosage of remifentanil,stay time in recovery room,before anesthesia(T_(0)),use of laryngeal mask(T_(1)),skin incision(T_(2)),removal of laryngeal mask(T_(3))hemodynamics[heart rate(HR),mean arterial pressure(MAP)],visual analog scale(VAS)scores at 2,8,12 and 24 hours after surgery and incidence of adverse reactions were compared between the two groups.Results The postoperative wake-up time and staying time in the recovery room of observation group were shorter than those of control group,and the dosage of remifentanil was less than that of control group(P<0.05).The MAP and HR levels of the two groups at T_(2)and T_(3)were higher than those at T_(0),and the MAP and HR levels of the two groups at T_(3)were higher than those at T_(1)(P<0.05).The MAP,HR levels at T_(2)and T_(3)of observation group were lower than those of control group(P<0.05).At 2,8,12 and 24 hours after operation VAS scores of observation group were lower than those of control group(P<0.05).There was no statistical difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The application of laryngeal mask reserved spontaneous breathing general anesthesia combined with ultrasound-guided nerve block in elderly patients undergoing hip arthroplasty can effectively shorten the postoperative recovery time and stay time in the recovery room,reduce the amount of anesthetics,reduce the fluctuation of MAP and HR during the operation,and reduce postoperative pain.