三低布比卡因和罗哌卡因腰硬联合对高龄患者髋关节置换术的麻醉效果、应激反应及炎性因子的影响研究

Effects of combined lumbar and epidural anesthesia with triple-low bupivacaine and ropivacaine on anesthetic effect,stress response and inflammatory factors in elderly patients undergoing hip replacement

目的 分析高龄患者髋关节置换术时给予三低布比卡因和罗哌卡因腰硬联合麻醉的效果及对应激反应和炎性因子的影响。方法 选取接受髋关节置换术治疗的高龄患者80例,随机分为对照组和观察组,各40例。对照组给予罗哌卡因腰硬联合麻醉,观察组给予三低布比卡因腰硬联合麻醉,比较两组患者麻醉效果和围手术期血流动力学、应激反应和炎性因子指标,统计两组麻醉相关不良反应发生率。结果 两组麻醉起效时间、运动神经和感觉阻滞持续时间和镇痛持续时间无显著差异(P>0.05)。两组T0的MAP和SpO2无显著差异(P>0.05);观察组T1、T2和T3的MAP和SpO2均高于对照组(P<0.05)。观察组术后CRH、ACTH、Cor、IL-1β、IL-6和TNF-α指标水平低于对照组(P<0.05)。观察组麻醉相关不良反应总发生率低于对照组(P<0.05)。结论 与罗哌卡因相比,对接受髋关节置换术的高龄患者应用三低布比卡因腰硬联合麻醉的效果较优,虽然两种麻醉药物方案麻醉效果相近,但是三低布比卡因麻醉方案对患者围手术期的血流动力学影响较小,应激-炎性反应较轻,麻醉不良反应较少,麻醉安全性较高。

Objective To analyze the effect of combined lumbar and epidural anesthesia with triple-low bupivacaine and ropivacaine on stress response and inflammatory factors in elderly patients undergoing hip replacement.Methods A total of 80 elderly patients who received hip catheterization in our hospital from March 2020 to October 2022 were enrolled as the research objects.They were divided into control group and observation group by random number table method,with 40 cases in each group.The control group was given ropivacaine combined with lumbar epidural anesthesia,while the observation group was given three-low bupivacaine combined with lumbar epidural anesthesia.The anesthetic effect and perioperative hemodynamics,stress response and inflammatory factors were compared between the two groups,and the incidence of anaesthesia related adverse reactions was statistically analyzed.Results There were no statistical significantly differences in the onset time of anesthesia,duration of motor nerve and sensory block and duration of analgesia between the two groups(P>0.05).There were no statistical significantly differences in mean arterial pressure(MAP)and oxygen saturation(SpO2)of T0 between the two groups(P>0.05).The MAP and SpO2 of T1,T2 and T3 in the observation group were higher than those in the control group(P<0.05).The levels of CRH,ACTH,Cor,IL-1β,IL-6 and TNF-αin the observation group were lower than those in the control group(P<0.05).The total incidence of anaesthesia related adverse reactions in the observation group was lower than that in the control group(P<0.05).Conclusion Compared with ropivacaine,three-low bupivacaine anesthesia in elderly patients undergoing hip arthroplasty,although the results of the two anesthetic drugs were similar,but the three-low bupivacaine anesthesia regimen there are less hemodynamic effects in the perioperative period,less stress-inflammatory reaction,less adverse anesthesia reactions,and higher safety of anesthesia.