不同麻醉方法在老年全髋关节置换术中的应用比较

Comparison of Different Anesthesia Methods in Older Patients Undergoing Total Hip Arthroplasty

目的 比较超声引导下髋关节囊周围神经(PEN)阻滞与常规腰丛神经(LPN)阻滞在老年全髋关节置换术(THA)中的效果,为麻醉方法的选择提供参考。方法 选择北京市大兴区人民医院2019年1月~2021年6月收治的82例行THA治疗的老年患者作为研究对象,按照随机数字表法分为PEN组与LPN组,各41例。PEN组于超声引导下行PEN阻滞,LPN组于超声引导下行常规LPN阻滞,比较两组神经阻滞操作时间、手术时间、术后24 h内舒芬太尼总用量、不良反应及术后2、8、12、24 h的疼痛数字评分量表(NRS)评分,调查患者对神经阻滞操作的满意度及舒适度。结果 两组神经阻滞成功率均为100%。PEN组神经阻滞操作时间短于LPN组,差异有统计学意义(P<0.05)。两组手术时间、术后镇痛泵首次按压时间、术后24 h内舒芬太尼总用量比较,差异均无统计学意义(P>0.05)。两组术后8、12、24 h的NRS评分均高于术后2 h,差异有统计学意义(P<0.05);但组间NRS评分比较,差异均无统计学意义(P>0.05)。PEN组患者对麻醉的满意度和舒适度均高于LPN组,差异均有统计学意义(P<0.05)。两组恶心呕吐,血压下降、心动过缓,呼吸抑制的发生率比较,差异均无统计学意义(P>0.05)。结论 老年THA患者于超声引导下PEN和LPN阻滞联合全麻均可获得满意的镇痛效果,但PEN阻滞操作时间短,患者舒适度和满意度更高。

Objective To compare the analgesic effect of ultrasound-guided hip pericapsular nerve(PEN)block and lumbar plexus nerve(LPN)block in older patients undergoing total hip arthroplasty(THA).Methods A total of 82 older patients with THA in Daxing District People's Hospital of Beijing from January 2019 to June 2021 were selected in this study.The patients were divided into a PEN group and a LPN group according to random number table,with 41 cases in each group.The PEN group was given PEN block under ultrasound guidance,and the LPN group was given conventional LPN block under ultrasound guidance.The following indicators were compared between the two groups,including the operation time of nerve block,duration of surgery,total dosage of Sufentanil within 24 hours after surgery,adverse reactions and scores of Numerical Rating Scale(NRS)at 2,8,12 and 24 hours after surgery.The satisfaction and comfort of patients with nerve block operation were investigated.Results The success rate of nerve block was 100%in both groups.The operation time of nerve block in PEN group was shorter than that in LPN group,and the difference was statistically significant(P<0.05).There were no significant differences in the duration of surgery,the first press time of postoperative analgesia pump,and the total dosage of Sufentanil within 24 hours after surgery between the two groups(P>0.05).NRS score at 8,12 and 24 hours after surgery was higher than that at 2 hours after surgery,and the difference was statistically significant(P<0.05),however,there was no significant difference in NRS score between the two groups(P>0.05).The degree of satisfaction and comfort with anesthesia in PEN group were higher than those in LPN group,and the differences were statistically significant(P<0.05).There were no significant differences in the incidences of nausea and vomiting,decreased blood pressure,bradycardia and respiratory depression between the two groups(P>0.05).Conclusion In older patients undergoing THA,both PEN and LPN block under ultrasound guidance can achieve satisfactory analgesic effect,but the PEN block operation time is shorter,andthe degree of comfort and satisfaction of patients are higher.