股神经阻滞联合帕瑞昔布在髋部手术中对患者血流动力学及呼吸循环功能的影响

Effect of femoral nerve block combined with Parecoxib on hemodynamics and respiratory and circulatory function in patients undergoing hip surgery

目的探究股神经阻滞联合帕瑞昔布在髋部手术中对患者血流动力学及呼吸循环功能的影响。方法前瞻性选取2020年1月至2021年12月重庆市中医骨科医院行髋部手术患者120例为研究对象,以随机数字表法分为对照组、观察组,每组各为60例,对照组在髋部手术中给予全身麻醉,观察组在对照组基础上施加股神经阻滞联合帕瑞昔布。比较两组麻醉前(T_(0))、、切口缝合时(T_(1))、术毕时(T_(2))、术后2 h(T_(3))不同时间段平均动脉压(MAP)、心率、呼气末二氧化碳分压(PETCO_(2))、血氧饱和度(SpO_(2)),并比较两组术后72 h的Harris髋关节功能评分量表(HSS)、视觉模拟评分法(VAS)评分差异。结果观察组T_(1)、T_(2)、T_(3)时间段的MAP分别为(67.32±2.46)、(70.02±2.39)、(72.11±2.27)mmHg,均较对照组[(68.38±2.20)、(73.50±2.44)、(76.36±2.38)mmHg]低,差异均有统计学意义(P<0.05)。观察组T_(1)、T_(2)、T_(3)时间段的心率分别为(104.03±3.12)、(101.43±3.70)、(96.50±3.69)次/min,均较对照组[(95.11±4.08)、(107.25±3.51)、(103.05±4.00)次/min]低,差异均有统计学意义(P<0.05)。观察组T_(1)、T_(2)、T_(3)时间段的PETCO_(2)为(38.24±1.34)、(37.02±1.39)、(36.48±1.37)mmHg,较对照组[(35.11±1.63)、(34.09±1.74)、(34.82±1.68)mmHg]高,差异均有统计学意义(P<0.05)。观察组T_(1)、T_(2)、T_(3)时间段的SpO_(2)分别为(96.51±1.32)%、(96.42±1.30)%、(96.81±1.54)%,均较对照组[(94.14±1.28)%、(94.61±1.34)%、(95.76±1.60)%]高,差异均有统计学意义(P<0.05)。术后72 h,观察组HSS评分为(62.76±5.27)分,较对照组[(57.40±6.18)分]高,VAS评分为(3.04±0.75)分,较对照组[(3.99±0.91)分]低,差异均有统计学意义(P<0.05)。结论股神经阻滞联合帕瑞昔布用于髋部手术中,不仅可稳定患者血流动力学及呼吸循环功能,缓解术后疼痛应激,还能促进髋关节恢复,值得推广。

Objective To explore the effect of femoral nerve block combined with Paroxycoxib on hemodynamics and respiratory and circulatory function in patients undergoing hip surgery.Methods One hundred and twenty patients with hip surgery admitted to Chongqing Traditional Chinese Medicine Orthopedic Hospital from January 2020 to December 2021 were prospectively selected as the study subjects.They were divided into control group and observation group according to the random number table method,with 60 patients in each group.The control group was given general anesthesia during hip surgery,and the observation group was given femoral nerve block combined with Parecoxib on the basis of the control group.The mean arterial pressure(MAP),heart rate,end expiratory partial pressure of carbon dioxide(PETCO_(2)),and oxygen saturation(SpO_(2))at different time points before anesthesia(T_(0)),at incision suture(T_(1)),at the end of surgery(T_(2)),and 2 hours after surgery(T_(3))were compared between the two groups.The hospital for special surgery knee score(HSS)and visual analog scale(VAS)scores aT_(7)2 hours after surgery were compared between the two groups.Results The MAP values of the observation group during the T_(1),T_(2),and T_(3)time periods were(67.32±2.46),(70.02±2.39),and(72.11±2.27)mmHg,respectively,which were lower than those of the control group[(68.38±2.20),(73.50±2.44),and(76.36±2.38)mmHg],and the differences were statistically significant(P<0.05).The heart rates of the observation group during the T_(1),T_(2),and T_(3)time periods were(104.03±3.12),(101.43±3.70)and(96.50±3.69)beats/min,respectively,which were lower than those of the control group[(95.11±4.08),(107.25±3.51),and(103.05±4.00)beats/min],and the differences were statistically significant(P<0.05).The PETCO_(2) levels in the observation group during the T_(1),T_(2),and T_(3)time periods were(38.24±1.34),(37.02±1.39),and(36.48±1.37)mmHg,which were higher than those in the control group[(35.11±1.63),(34.09±1.74),and(34.82±1.68)mmHg],and the differences were statistically significant(P<0.05).The SpO_(2) levels of the observation group during the T_(1),T_(2),and T_(3)time periods were(96.51±1.32)%,(96.42±1.30)%,and(96.81±1.54)%,respectively,which were higher than those of the control group[(94.14±1.28)%,(94.61±1.34)%,and(95.76±1.60)%],and the differences were statistically significant(P<0.05).72 hours after surgery,the HSS score of the observation group was(62.76±5.27)points,which was higher than that of the control group[(57.40±6.18)points],and the VAS score was(3.04±0.75)points,which was lower than that of the control group[(3.99±0.91)]points,the differences were statistically significant(P<0.05).Conclusion The use of femoral nerve block combined with parecoxib in hip surgery can not only stabilize the hemodynamics and respiratory and circulatory functions of patients,relieve postoperative pain stress,but also promote the recovery of hip joint,which is worthy of promotion.