低剂量轻比重脊椎麻醉及神经阻滞麻醉用于髋关节置换术的临床研究

Clinical study of low-dose and light specific gravity spinal anesthesia and nerve block anesthesia for hip arthroplasty

目的比较低剂量轻比重脊椎麻醉和神经阻滞麻醉用于髋关节置换术的效果。方法选取2020年1月至2021年1月该院择期拟行髋关节置换术的120例患者为研究对象,按照随机数字表法分为轻比重脊椎麻醉组和神经阻滞组,每组60例。比较两组基线资料及手术相关指标,观察两组术中辅助用药情况及麻醉效果(麻醉起效时间、感觉阻滞持续时间及运动阻滞持续时间),麻醉前、术毕、术后30 min各时点平均动脉压(MAP)及心率(HR)变化情况,麻醉前、术毕、术后24 h各时点应激反应指标[儿茶酚胺(CA)、血清皮质醇(CORT)]水平变化,并比较两组并发症发生情况。结果轻比重脊椎麻醉组在术中未使用静脉麻醉药物辅助,神经阻滞组14例增加了静脉辅助药物以达到完善的镇痛效果。与神经阻滞组比较,轻比重脊椎麻醉组麻醉起效时间、感觉阻滞持续时间及运动阻滞持续时间更短,差异有统计学意义(P<0.05)。神经阻滞组术毕MAP较麻醉前降低,术后30 min MAP较术毕升高,且术毕MAP低于轻比重脊椎麻醉组,差异有统计学意义(P<0.05)。术毕两组CA、CORT水平较麻醉前升高,术后24 h轻比重脊椎麻醉组CORT和神经阻滞组CA、CORT水平较术毕降低,且术毕及术后24 h轻比重脊椎麻醉组CORT水平低于神经阻滞组,差异有统计学意义(P<0.05)。两组术后并发症发生情况比较,差异无统计学意义(P>0.05)。结论低剂量轻比重脊椎麻醉用于髋关节置换术价值较高。

Objective To compare the effects of low-dose light specific gravity spinal anesthesia and nerve block anesthesia in hip arthroplasty.Methods From January 2020 to January 2021,a total of 120 patients scheduled for hip replacement in this hospital were selected and divided into the light specific gravity spinal anesthesia group and the nerve block group according to random number table method,with 60 cases in each group.The baseline data and operation related indexes were compared between the two groups.The intraoperative auxiliary medication and anesthetic effect(anesthesia onset time,sensory block duration and motor block duration)were analyzed.The changes of mean arterial pressure(MAP)and heart rate(HR)were observed before anesthesia,after operation and 30 min after operation.The changes of stress response indexes[catecholamine(CA)and serum cortisol(CORT)]were observed before and after anesthesia and 24 hours after anesthesia,and the complications of the two groups were compared.Results In the light specific gravity spinal anesthesia group,intravenous anesthetics were not used during the operation;in the nerve block group,14 patients added intravenous adjuvant drugs to achieve perfect analgesic effect.The onset time of anesthesia,duration of sensory block and duration of motor block in the light specific gravity spinal anesthesia group were significantly shorter than those in the nerve block group(P<0.05).The MAP at the end of operation in the nerve block group was significantly lower than that before anesthesia,the MAP at 30 min after operation was significantly higher than that at the end of operation,and the post-operative MAP was lower than that of the light specific gravity spinal anesthesia group,and the difference was statistically significant(P<0.05).The levels of CA and CORT at the end of operation in both groups were significantly higher than those before anesthesia;at 24 hours after operation,CORT in the light spinal anesthesia group was significantly lower than that at the end of operation,CA and CORT in nerve block group were significantly lower than that at the end of operation,and CORT level at the end of operation and 24 h after operation in the light specific gravity spinal anesthesia group was significantly lower than that in the nerve block group,and the difference was statistically significant(P<0.05).There was no significant difference in the postoperative complications between the two groups(P>0.05).Conclusion Low-dose and light specific gravity spinal anesthesia is of high value in hip arthroplasty.