超声引导腰骶丛神经阻滞和脊椎麻醉应用于老年膝关节置换术的效果比较

Comparison of the effect of ultrasound-guided lumbosacral plexus block and spinal anesthesia in elderly patients undergoing total knee arthroplasty

目的比较超声引导腰骶丛神经阻滞和脊椎麻醉应用于老年膝关节置换术的效果。方法选取2020年9月至2022年3月昭通市第一人民医院收治的76例行全膝关节置换术患者作为研究对象,按照随机数字表法将其分为腰骶丛神经阻滞(LSPB)组(38例)与脊椎麻醉(SA)组(38例)。LSPB组患者采用超声引导腰骶丛神经阻滞方法,SA组患者采用脊椎麻醉方法。比较两组患者入手术室(T1)、麻醉后5 min(T2)、麻醉后15 min(T3)、切皮时(T4)、切皮后60 min(T5)的平均动脉压(MAP),比较两组患者的麻醉持续时间、手术时间、术中出血量和输液量,比较两组患者术后4、8、12、24 h的疼痛视觉模拟评分法(VAS)评分,比较两组患者的术中舒芬太尼、麻黄碱、去甲肾上腺素的用量,比较两组患者术后72h的尿潴留、头痛和恶心呕吐发生率。结果LSPB组T2、T3、T4、T5时点的MAP均高于SA组,差异有统计学意义(P<0.05);LSPB组术后4、8、12、24 h的VAS评分低于SA组,差异有统计学意义(P<0.05);两组患者的手术时间和术中出血量比较,差异无统计学意义(P>0.05);LSPB组的麻醉持续时间长于SA组,输液量少于SA组,差异有统计学意义(P<0.05);LSPB组术中使用麻黄碱、去甲肾上腺素和输液量低于SA组,差异有统计学意义(P<0.05);LSPB组术后72 h的头痛、恶心呕吐和尿潴留发生率均低于SA组,差异有统计学意义(P<0.05);两组患者的舒芬太尼用量比较,差异无统计学意义(P>0.05)。结论超声引导腰骶丛神经阻滞应用于老年膝关节置换术麻醉效果好,较少影响患者术中的血压,且提供更好的术后镇痛,减少术后并发症。

Objective To compare the effect of ultrasound-guided lumbosacral plexus block and spinal anesthesia in elderly patients undergoing total knee arthroplasty.Methods A total of 76 patients who underwent total knee arthroplasty in the First People's Hospital of Zhaotong from September 2020 to March 2022 were selected as the research objects.According to the random number table method,they were divided into lumbosacral plexus block(LSPB)group(38 cases)and spinal anesthesia(SA)group(38 cases).The LSPB group was treated with ultrasound-guided lumbosacral plexus block,and the SA group was treated with spinal anesthesia.The mean arterial pressure(MAP)at admission(T1),5 min after anesthesia(T2),15 min after anesthesia(T3),skin incision(T4)and 60 min after skin incision(T5)were compared between the two groups.The duration of anesthesia,operation time,intraoperative blood loss and infusion volume were compared between the two groups.The visual analogue scale(VAS)scores of pain at 4,8,12 and 24 h after operation were compared between the two groups.The intraoperative consumption of Sufentanil,Ephedrine and Norepinephrine were compared between the two groups.The incidences of urinary retention,headache,nausea and vomiting at 72 h after operation were compared between the two groups.Results The MAP of LSPB group at T2,T3,T4 and T5 were higher than those of SA group,and the differences were statistically significant(P<0.05).The VAS scores at 4,8,12 and 24 h after operation in LSPB group were lower than those in SA group,and the differences were statistically significant(P<0.05).There were no significant differences in operation time and intraoperative blood loss between the two groups(P>0.05).The duration of anesthesia in the LSPB group was longer than that in the SA group,and the infusion volume was less than that in the SA group,and the differences were statistically significant(P<0.05).The intraoperative use of Ephedrine,Norepinephrine and infusion volume in LSPB group were lower than those in SA group,and the differences were statistically significant(P<0.05).The incidence of headache,nausea and vomiting and urinary retention in the LSPB group were lower than those in the SA group 72 h after operation,with statistically significant differences(P<0.05).There was no significant difference in the dosage of Sufentanil between the two groups(P>0.05).Conclusion Ultrasound-guided lumbosacral plexus block has a good anesthetic effect in elderly patients undergoing total knee arthroplasty,with less influence on intraoperative blood pressure,better postoperative analge-sia and fewer postoperative complications.