强直性脊柱炎患者全髋关节置换术中联合应用神经阻滞麻醉的效果

Effect of nerve block anesthesia combined with total hip arthroplasty in patients with ankylosing spondylitis

目的:探讨腰丛阻滞(LPB)联合坐骨神经阻滞、髂筋膜阻滞(FICB)联合坐骨神经阻滞在强直性脊柱炎(AS)患者全髋关节置换(THA)术中的临床应用。方法:按照麻醉方式不同将75例行全髋关节置换术的AS患者分为观察组(n=38)和对照组(n=37)。两组患者均行全麻,同时观察组患者麻醉诱导前行LPB联合坐骨神经阻滞,对照组行FICB联合坐骨神经阻滞,对比两组患者围术期相关指标。结果:观察组患者术中丙泊酚、瑞芬太尼用量少于对照组,手术时间短于对照组,差异均具有统计学意义(P<0.05)。观察组患者扩髓时、植入假体时心率低于对照组,观察组手术切皮、扩髓、植入假体、缝合切口时刻的平均动脉压均低于对照组,差异均具有统计学意义(P<0.05),两组患者围术期各时间点的血氧饱和度比较,差异无统计学意义(P>0.05)。两组患者的住院时间及术前、术后4、12、24 h的视觉疼痛模拟评分法(VAS)评分、术后恶心呕吐发生率比较,差异均无统计学意义(P>0.05)。结论:强直性脊柱炎患者全髋关节置换术中应用LPB联合坐骨神经阻滞、FICB联合坐骨神经阻滞,均可有效减轻术后疼痛,LPB对AS患者在THA术中血流动力学指标影响较小,同时可减少术中麻醉药物使用量,手术时间长于FICB联合坐骨神经阻滞。

Objective:To explore the clinical application of lumbar plexus block(LPB) combined with sciatic fascia and iliac block(FICB) combined with sciatic nerve block in patients with ankylosing spondylitis(AS) after total hip arthroplasty(THA).Methods:A total of 75 patients with AS involving the hip joint were selected, and they were divided into an observation group(n=38) and a control group(n=37) according to different anesthesia methods.Both groups received general anesthesia, while the observation group received LPB combined with sciatic nerve block before anesthesia induction, and the control group received FICB combined with sciatic nerve block.The perioperative parameters of the two groups were compared.Results:The intraoperative dosage of propofol, remifentanil in the observation group was less than that in the control group, and the operation time was shorter than that in the control group, and the difference was statistically significant(P<0.05).The heart rate of patients in the observation group was lower than that in the control group at the time of reaming, implantation of the prosthesis, and the mean arterial pressure in the observation group at the time of skin incision, reaming, implantation of the prosthesis, suture incision was lower than that in the control group, and the difference was statistically significant(P<0.05).There was no significant difference in blood oxygen saturation at each time point during the perioperative period between the two groups(P>0.05).There was no significant difference in the length of hospital stay, the Visual analogue scale(VAS) before surgery and 4,12,and 24 h after surgery and the incidence of postoperative nausea and vomiting between the two groups(P>0.05).Conclusion:The application of LPB combined with sciatic nerve block and FICB combined with sciatic nerve block in total hip arthroplasty in patients with ankylosing spondylitis can effectively reduce postoperative pain.LPB has little effect on hemodynamic indexes of patients with AS during THA operation, and can reduce the use of intraoperative anesthetic drugs.The operation time is longer than that of FICB combined with sciatic nerve block.