超声引导下腰丛神经阻滞联合静吸复合全身麻醉在老年髋关节置换术中的应用效果

Application Effect of Ultrasound-Guided Lumbar Plexus Block Plus Combined Intravenous-Inhalation General Anesthesia in Elderly Hip Replacement

目的:探讨超声引导下腰丛神经阻滞联合静吸复合全身麻醉在老年髋关节置换术中的应用效果。方法:选取2019年5月—2021年9月于肇庆市第一人民医院行髋关节置换术的老年患者50例作为研究对象,按照随机数字表法分为对照组和观察组,各25例。对照组行静吸复合全身麻醉,观察组行超声引导下腰丛神经阻滞联合静吸复合全身麻醉。比较两组麻醉效果。结果:观察组手术时间短于对照组、出血量少于对照组,深静脉血栓(DVT)发生率低于对照组,差异有统计学意义(P<0.05)。两组术前(T_(0))、麻醉开始1 h、手术结束后1 h(T_(2))时凝血活酶生成时间(R-CK)、凝固时间(K)、凝血块强度(G)、血栓最大值(MA)、凝血综合指数(CL)、血栓最大值确定后30 min血凝块幅度减少速率(LY30)值比较,差异无统计学意义(P>0.05);对照组T_(2)时的R-CK、K、G值低于T_(0),MA、CL、LY30值高于T_(0),差异有统计学意义(P<0.05)。结论:超声引导下腰丛神经阻滞联合静吸复合全身麻醉在老年髋关节置换术中的应用效果较好,能够缩短手术时间,减少患者出血量,降低DVT发生率。

Objective:To explore the application of ultrasound-guided lumbar plexus block plus combined intravenous-inhalation general anesthesia in elderly hip replacement.Methods:A total of 50 elderly patients undergoing hip replacement in the First People's Hospital of Zhaoqing from May 2019 to September 2021 were selected as the study subjects.They were divided into control group and observation group according to random number table method,with 25 cases in each group.The control group underwent the combined intravenous-inhalation general anesthesia,and the observation group underwent ultrasound-guided lumbar plexus block plus combined intravenous-inhalation general anesthesia.The anesthesia effect was compared between two groups.Results:The operation time in the observation group was shorter than that in the control group,the blood loss in the observation group was less than that in the control group,and the incidence of deep vein thrombosis(DVT)in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in thromboplastin generation time(R-CK),clotting time(K),clot strength(G),maximum amplitude(MA)of thrombus,coagulation index(CL),and blood clot amplitude reduction rate at 30 min after the maximum amplitude was reached(LY30)between the two groups before operation(T_(0)),at 1 h after the start of anesthesia,and at 1 h after the end of surgery(T_(2))(P>0.05).The values of R-CK,K and G at T_(2) in the control group were lower than those at T_(0),and the values of MA,CL and LY30 in the control group at T_(2) were higher than those at T_(0),and the difference was statistically significant(P<0.05).Conclusion:Ultrasound-guided lumbar plexus block plus combined intravenous-inhalation general anesthesia has a good application effect in elderly hip replacement,and can shorten the operation time,reduce the amount of blood loss and reduce the incidence of DVT.