喉罩全麻联合超声引导下臂丛神经阻滞对老年患者血流动力学的影响

Effect of Laryngeal Mask General Anesthesia Combined with Ultrasoundguided Brachial Plexus Block on Hemodynamics in Elderly Patients

目的研究喉罩全麻联合超声引导下臂丛神经阻滞对老年患者血流动力学的影响。方法选择江苏省常州市武进人民医院2018年3月—2021年3月需要接受手术治疗的74例老年上肢骨折伴心血管病变患者为该研究对象,按照随机数字表法分为两组,对照组37例接受气管插管全麻联合臂丛神经阻滞麻醉,观察组37例接受喉罩全麻联合超声引导下臂丛神经阻滞,比较两组血流动力学、应激状况。结果对照组插管时、拔管时的心率(HR)水平高于麻醉诱导前[(78.85±8.94)次/min、(80.69±8.15)次/min vs(73.15±10.24)次/min],差异有统计学意义(F=35.849,P<0.05),平均动脉压(MAP)水平高于麻醉诱导前[(90.42±9.57)mmHg、(93.76±10.54)mmHg vs(85.21±11.12)mmHg],差异有统计学意义(F=29.134,P<0.05)。观察组置入喉罩时、拔喉罩时HR水平低于对照组[(74.13±6.28)次/min、(76.51±7.12)次/min vs(78.85±8.94)次/min、(80.69±8.15)次/min],差异有统计学意义(t=2.628、2.349,P<0.05),MAP水平低于对照组[(85.61±8.42)mmHg、(87.62±8.89)mmHg vs(90.42±9.57)mmHg、(93.76±10.54)mmHg],差异有统计学意义(t=2.295、2.709,P<0.05)。后4个时间点相较麻醉诱导前观察组心钠素(ANP)明显升高,对照组后4个时间点较麻醉诱导前血浆去甲肾上腺素(NE)、血清皮质醇(Cor)、ANP明显升高,差异有统计学意义(P<0.05);观察组后4个时间点NE、Cor、ANP均低于对照组,差异有统计学意义(P<0.05)。结论老年手术患者采取喉罩全麻联合超声引导下臂丛神经阻滞可减轻对血流动力学的影响,减轻应激。

Objective To study the effect of laryngeal mask general anesthesia combined with ultrasound-guided brachial plexus block on hemodynamics in elderly patients.Methods A total of 74 elderly patients with upper extremity fractures and cardiovas⁃cular lesions who needed surgical treatment from March 2018 to March 2021 in Wujin People's Hospital of Changzhou City,Ji⁃angsu Province were selected as the research objects,and divided into two groups according to the random number table method,the control group of 37 cases received general anesthesia with tracheal intubation combined with brachial plexus block anesthesia,while 37 cases in the observation group received general anesthesia with laryngeal mask combined with ultrasoundguided brachial plexus block.The hemodynamics and stress status of the two groups were compared.Results The heart rate(HR)level of the control group during intubation and extubation was higher than that before induction of anesthesia[(78.85±8.94)times/min,(80.69±8.15)times/min vs(73.15±10.24)times/min],and the differences were statistically significant(P<0.05).The mean arterial pressure(MAP)level was higher than that before anesthesia induction[(90.42±9.57)mmHg,(93.76±10.54)mmHg vs(85.21±11.12)mmHg],the difference was statistically significant(F=29.134,P<0.05).The HR level of the observation group when the laryngeal mask was inserted and removed was lower than that of the control group[(74.13±6.28)times/min,(76.51±7.12)times/min vs(78.85±8.94)times/min,(80.69±8.15)times/min],the difference was statistically significant(t=2.628,2.349,P<0.05),the MAP level was lower than the control group[(85.61±8.42)mmHg,(87.62±8.89)mmHg vs(90.42±9.57)mmHg,(93.76±10.54)mmHg],the difference was statistically significant(t=2.295,2.709,P<0.05).Atrial natriuretic hormone(ANP)in the observation group was signifi⁃cantly higher than that before induction of anesthesia at the last four time points significantly increased,and the difference was statis⁃tically significant(P<0.05);NE,Cor,and ANP in the observation group were lower than those in the control group at four time points afterward,and the difference was statistically significant(P<0.05).Conclusion Laryngeal mask general anesthesia combined with ultrasound-guided brachial plexus block in elderly surgical patients can reduce the impact on hemodynamics and reduce stress.