超声引导下神经阻滞复合喉罩全身麻醉在老年髋关节置换手术患者中的应用研究

Application of ultrasound-guided nerve block combined with laryngeal mask general anesthesia in elderly patients with hip replacement surgery

目的探讨超声引导下神经阻滞复合喉罩全身麻醉在老年髋关节置换手术患者中的效果。方法选取2019年10月至2021年10月泉州市正骨医院收治的76例老年髋关节置换手术患者作为研究对象,按随机数字表法分为对照组与观察组,每组38例。对照组给予静吸复合气管插管全身麻醉,观察组给予超声引导下神经阻滞复合喉罩全身麻醉。比较两组血流动力学、麻醉与手术情况、疼痛程度及不良反应发生情况。结果T_(0)时,两组心率(HR)、舒张压(DBP)、收缩压(SBP)均低于T_(1)~T_(4)时,对照组HR、DBP均低于T_(2)、T_(3),高于T_(4),但SBP低于T_(2),高于T_(3)、T_(4),观察组HR、DBP、SBP均低于T_(2),高于T_(4),T_(2)时,两组HR、DBP、SBP均高于T_(3)、T_(4),T_(3)时,两组HR、DBP、SBP均高于T_(4),差异有统计学意义(P<0.05);观察组内其余时间点比较差异无统计学意义。T_(0)时,两组HR、DBP、SBP比较差异无统计学意义;T_(1)~T_(4)时,观察组HR、DBP、SBP均低于对照组,差异有统计学意义(P<0.05)。两组视觉模拟评分法(VAS)评分组间、时间、交互比较差异有统计学意义(P<0.05);术后6、12、24h,两组VAS评分均低于前一时间点,且观察组低于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义。结论超声引导下神经阻滞复合喉罩全身麻醉可稳定老年髋关节置换手术患者手术时的血流动力学,有效缩短麻醉与拔管时间,减轻术后疼痛,且无严重不良反应,安全可行,临床应用价值较高。

Objective To investigate the effect of ultrasound-guided nerve block combined with laryngeal mask general anesthesia in elderly pa-tients with hip replacement surgery.Methods 76 elderly patients with hip replacement surgery who were admitted to Quanzhou Orthopaedic Hospi-tal from October 2019 to October 2021 were selected as the research subjects,and they were divided into the control group and the observation group according to the random number table method,with 38 cases in each group.The control group was given general anesthesia with intravenous inhala-tion combined with tracheal intubation,and the observation group was given with ultrasound-guided nerve block combined with laryngeal mask gen-eral anesthesia.The hemodynamics,anesthesia and operation,pain degree and adverse reactions were compared between the two groups.Results At T_(0),the heart rate(HR),diastolic blood pressure(DBP)and systolic blood pressure(SBP)of the two groups were lower than those at T_(1)-T_(4),the HR and DBP in the control group were lower than those at T_(2) and T_(3),higher than those at T_(4),but the SBP was lower than that at T_(2),higher than that at T_(3) and T_(4),the HR,DBP and SBP in the observation group were lower than those at T_(2),higher than those at T_(4),at T_(2),the HR,DBP and SBP of the two groups were higher than those at T_(3) and T_(4),at T_(3),the HR,DBP and SBP of the two groups were higher than those at T_(4),and the differences were sta-tistically significant(P<0.05);there was no significant difference at other time points in the observation group.At T_(0),there was no significant differ-ence in HR,DBP and SBP between the two groups;at T_(1)-T_(4),the HR,DBP and SBP in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).There were significant differences of the visual analogue scale(VAS)score be-tween two groups of group,time points and interaction(P<0.05);at 6,12 and 24 h after operation,the VAS scores of the two groups were lower than those at the previous time point,and the observation group was lower than the control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Ultrasound-guided nerve block combined with laryngeal mask general anesthesia can maintain stable hemodynamics in elderly patients with hip replacement surgery,effectively shorten the time of anesthesia and extubation,reduce postoperative pain,and has no serious adverse reactions,which is safe and feasible,and the clin-ical application value is high.