超声引导腰部竖脊肌平面阻滞在老年患者髋关节置换术中的应用效果

Effect of ultrasound-guided lumbar erector spinae plane block in elderly patients undergoing hip replacement

目的探讨超声引导腰部竖脊肌平面阻滞(L-ESPB)在老年患者髋关节置换术中的应用效果。方法选择2020年8月至2021年3月于济宁市第一人民医院60例行单侧髋关节置换术的老年患者,根据随机数字表法分为A组(n=30)和B组(n=30)。两组均行喉罩全麻,A组全麻前行L-ESPB。比较两组平均动脉压(MAP)、心率(HR)、全麻药用量、全麻苏醒指标、术后VAS评分、镇痛效果及不良反应发生率和术后康复指标。结果A组T_(2)~T_(6)时MAP、HR低于B组,B组T_(2)~T_(6)时MAP、HR高于T_(1),差异有统计学意义(P<0.05);A组T_(2)~T_(6)时MAP、HR与T_(1)比较差异无统计学意义(P>0.05)。与B组比较,A全麻药用量减少,术后拔喉罩时间、苏醒期躁动发生率、术后VAS评分、镇痛泵有效按压次数、镇痛补救率及恶心呕吐发生率降低,术后首次下床活动时间缩短,髋关节最大屈曲度和外展度增加,差异有统计学意义(P<0.05)。两组头晕、尿潴留发生率及术后肌力评分差异无统计学意义(P>0.05)。结论超声引导L-ESPB用于老年患者髋关节置换术,可维持术中血流动力学平稳,减少全麻药用量,提供完善镇痛效果,降低术后并发症发生率,提高苏醒质量,有利于早期康复。

Objective To explore the effect of ultrasound-guided lumbar erector spinae plane block(L-ESPB)in elderly patients undergoing hip replacement.Methods A total of 60 elderly patients who underwent unilateral hip replacement in Jining No.1 People’s Hospital from August 2020 to March 2021 were selected and randomly divided into group A(n=30)and group B(n=30).Both groups were given laryngeal mask anesthesia for general anesthesia,and group A was given L-ESPB before general anesthesia.The mean arterial pressure(MAP)and heart rate(HR),amount of general anesthetics,awakening index of general anesthesia,Visual Analogue Scale(VAS)score,analgesic effect and incidence of adverse reactions and rehabilitation indicators after operation were compared between the two groups.Results MAP and HR in group A were lower than thos e in group B from T_(2)to T_(6),while MAP and HR in group B were higher from T_(2)to T_(6)than those at T_(1),with statistically significant differences(P<0.05).There were no significant differences in MAP and HR in group A from T_(2)to T_(6)compared with T_(1)(P>0.05).Compared with group B,the amount of general anesthetics in group A decreased,the time to pull out laryngeal mask airway,the incidence of restlessness in awakening period,the postoperative VAS score,the effective pressing times of analgesic pump,the recovery rate of analgesia and the incidence of nausea and vomiting were decreased,the time to get out of bed for the first time after operation shortened,and the maximum flexion and abduction of hip joint increased,with statistically significant differences(P<0.05).There were no significant differences in the incidence of dizziness,urinary retention and postoperative muscle strength score between the two groups(P>0.05).Conclusion Ultrasound-guided L-ESPB in elderly patients undergoing hip replacement can maintain the hemodynamic stability during operation,reduce the am ount of general anes thetics,provide perfect analgesic effect,reduce the incidence of postoperative complications,improve the quality of recovery and facilitate early rehabilitation.