超声下神经阻滞复合全麻在老年髋关节置换术患者中的应用研究

Application of Nerve Block Combined with General Anesthesia under Ultrasound in Elderly Patients Undergoing Total Hip Replacement

目的 分析老年髋关节置换术(total hip replacement,THR)患者应用超声下神经阻滞复合全麻取得的效果。方法 随机选取2020年1月—2022年3月于江苏省靖江市中医院行THR手术的老年患者60例为研究对象,以随机数表法分为对照组(30例)与研究组(30例)。对照组采用全麻方案,研究组采用超声下神经阻滞复合全麻。针对两组麻醉时间、苏醒时间、术后48 h自控镇痛按压次数、不同时间血流动力学指标,以及不良反应进行比较。结果 两组麻醉时间比较,差异无统计学意义(P>0.05);研究组苏醒时间(5.65±1.15)min、术后48 h自控镇痛按压次数(10.52±2.32)次较对照组(7.20±1.20)min、(18.65±1.89)次低,差异有统计学意义(t=5.108、14.881,P<0.05)。两组麻醉前(T_(0))心率(HR)与平均动脉压(MAP)指标比较,差异无统计学意义(P>0.05);研究组开始置换髋关节(T_(1))与完成手术(T_(2))时HR与MAP指标较对照组低,差异有统计学意义(P<0.05)。不良反应比较中,研究组发生率6.67%较对照组30.00%低,差异有统计学意义(χ^(2)=5.455,P<0.05)。结论 THA患者应用超声下神经阻滞复合全麻效果确切,具有临床推广价值。

Objective To analyze the effect of nerve block under ultrasound combined with general anesthesia in elderly patients undergoing total hip replacement(THR).Methods Sixty elderly patients who underwent THA surgery in Jingjiang Hospital of Traditional Chinese Medicine from January 2020 to March 2022 were randomly selected as the research subjects,and were divided into control group(30 cases)and study group(30 cases)by random number table method.The control group received general anesthesia,and the study group received subultrasonic nerve block combined with general anesthesia.Anesthesia time,recovery time,the number of self-controlled analgesia presses 48 h after surgery,hemodynamic indexes at different times,and adverse reactions were compared between the two groups.Results There was no statistically significant difference in anesthesia duration between the two groups(P>0.05).The recovery time of the study group was(5.65±1.15)min,and the number of self-controlled analgesic compression 48 h after surgery was(10.52±2.32)times,lower than those of the control group(7.20±1.20)min and(18.65±1.89)times,and the difference was statistically significant(t=5.108,14.881,P<0.05).There was no statistically significant difference in heart rate(HR)and mean arterial pressure(MAP)between the two groups before anesthesia(T_(0))(P>0.05).HR and MAP indexes of the study group were lower than those of the control group at the time points of initiation of hip replacement(T_(1))and completion of surgery(T_(2)),and the difference was statistically significant(P<0.05).In the comparison of adverse reactions,the incidence rate of 6.67%in the study group was lower than 30.00%in the control group,and the difference was statistically significant(χ^(2)=5.455,P<0.05).Conclusion The effect of nerve block combined with general anesthesia under ultrasound in patients with THA is accurate and has the value of clinical promotion.