超声引导下前路髂腰肌间隙阻滞联合侧路骶丛阻滞对老年髋关节置换手术镇痛效果及应激呼吸循环的影响

Effect of Ultrasound-guided Anterior Iliopsoas Space Block Combined with Lateral Sacral Plexus Block on Analgesic Effect and Stress Respiratory Circulation in Elderly Patients Undergoing Hip Replacement Surgery

目的研究超声引导下前路髂腰肌间隙阻滞联合侧路骶丛阻滞对老年髋关节置换手术镇痛效果及应激呼吸循环的影响。方法选取2019年6月-2022年6月在我院行髋关节置换手术的104例老年患者为研究对象,采用随机数字表法分为对照组和观察组,各52例。对照组采用全麻,观察组采用超声引导下前路髂腰肌间隙阻滞联合侧路骶丛阻滞,比较两组不同时间点心率(HR)、血压[收缩压(SBP)、舒张压(DBP)]、血氧饱和度(SpO_(2))以及呼吸频率(RR)水平、术后不同时间段疼痛评分、麻醉起效时间、首次下床活动时间、不同时间点认知功能评分、不良反应发生率。结果与T0时刻比较,T1、T2、T3时间段SBP、DBP、HR、RR均有不同程度的下降,HR均有不同程度升高,且观察组SBP、DBP、HR、RR低于对照组,HR高于对照组(P<0.05);观察组T4与T0时间段各指标比较,差异无统计学意义(P>0.05),对照组T4时间段各指标均低于T0(P<0.05);观察组术后1、6、12 h疼痛评分均低于对照组(P<0.05),24、48 h疼痛评分与对照组比较,差异无统计学意义(P>0.05);观察组麻醉起效时间、首次下床活动时间均小于对照组(P<0.05);术后2、6 h认知功能评分均低于术前,但观察组高于对照组(P<0.05),术后24 h认知功能评分与术前比较,差异无统计学意义(P>0.05);观察组不良反应发生率为7.69%,低于对照组的19.23%(P<0.05)。结论在老年髋关节置换术中采用超声引导下前路髂腰肌间隙阻滞联合侧路骶丛阻滞麻醉,临床镇痛效果确切,对呼吸循环、生命体征、认知功能影响较小,是一种安全、有效的麻醉方式。

Objective To study the effect of ultrasound-guided anterior iliopsoas space block combined with lateral sacral plexus block on analgesia and stress respiration and circulation in elderly patients undergoing hip replacement.Methods A total of 104 elderly patients who underwent hip replacement surgery in our hospital from June 2019 to June 2022 were selected as the research objects.They were divided into control group and observation group by random number table method,with 52 patients in each group.The control group was treated with general anesthesia,and the observation group was treated with ultrasound-guided anterior iliopsoas space block combined with lateral sacral plexus block.The heart rate(HR),blood pressure[systolic blood pressure(SBP),diastolic blood pressure(DBP)],blood oxygen saturation(SpO_(2))and respiratory rate(RR)levels at different time points,pain scores at different time points after surgery,onset time of anesthesia,first time to get out of bed,cognitive function scores at different time points,and incidence of adverse reactions were compared between the two groups.Results Compared with T0,SBP,DBP,HR and RR at T1,T2 and T3 decreased to varying degrees,and HR increased to varying degrees,while SBP,DBP,HR and RR in the observation group were lower than those in the control group,and HR was higher than that in the control group(P<0.05).There was no significant difference in the indexes between T4 and T0 in the observation group(P>0.05),but the indexes of T4 in the control group were lower than those of T0(P<0.05).The pain scores at 1,6 and 12 h after operation in the observation group were lower than those in the control group(P<0.05),and there was no significant difference in pain scores at 24 and 48 h after operation between the two groups(P>0.05).The onset time of anesthesia and the time of first ambulation in the observation group were less than those in the control group(P<0.05).The cognitive function score at 2 and 6 h after operation was lower than that before operation,but that in the observation group was higher than that in the control group(P<0.05).There was no significant difference in cognitive function score between 24 h after operation and before operation(P>0.05).The incidence of adverse reactions in the observation group was 7.69%,which was lower than 19.23%in the control group(P<0.05).Conclusion Ultrasound-guided anterior iliopsoas space block combined with lateral sacral plexus block anesthesia in elderly hip replacement has a definite clinical analgesic effect,and has little effect on respiratory circulation,vital signs and cognitive function.It is a safe and effective anesthesia method.