腰骶丛神经阻滞复合喉罩全身麻醉在老年全髋关节置换术患者中的应用

Application of Lumbar and Sacral Plexus Block Combined with Laryngeal Mask Anesthesia in Elderly Patients Undergoing Total Hip Arthroplasty

目的探讨腰骶丛神经阻滞(LPB)复合喉罩全身麻醉(LMGA)在老年全髋关节置换术(THA)中的应用效果。方法选取2022年1月至2023年8月在南阳市中心医院接受THA治疗的60例老年患者,以随机数字表法分为研究组(n=30)与对照组(n=30),对照组实行LMGA,研究组实行LPB复合LMGA,对两组围术期指标、疼痛程度、血流动力学、认知功能、不良事件发生情况进行比较。结果研究组麻醉起效时间、拔管时间、苏醒时间、下床活动时间及住院时间均短于对照组,差异具有统计学意义(P<0.05);两组术后6 h、12 h、24 h视觉模拟评分(VAS)较术后2 h下降,且同时段研究组VAS评分均低于对照组,差异具有统计学意义(P<0.05);研究组插入喉罩时(T_(1))、切皮时(T_(2))、植入假体时(T_(3))心率(HR)较麻醉前(T0)升高,T_(2)平均动脉压(MAP)较T0升高,差异具有统计学意义(P<0.05),对照组T_(1)、T_(2)、T_(3)、手术结束时(T_(4))的HR、MAP较T0升高,差异具有统计学意义(P<0.05),研究组T_(1)、T_(2)、T_(3)、T_(4)的HR、MAP较对照组低,差异具有统计学意义(P<0.05);两组术后1 d、3 d的简易智力状态检查量表(MMSE)评分较术前下降,但术后同时段研究组MMSE评分较对照组高,差异具有统计学意义(P<0.05);研究组不良事件发生率(6.67%)低于对照组(30.00%),差异具有统计学意义(P<0.05)。结论LPB复合LMGA应用于老年THA患者中,能够提高麻醉效果,缩短苏醒、住院时间,降低疼痛程度,对血流动力学、认知功能影响较小,减少发生不良事件。

Objective To explore the application effect of posterior lumbar plexus block(LPB)compounded with laryngeal mask general anesthesia(LMGA)in elderly total hip arthroplasty(THA).Methods A total of 60 elderly patients who underwent THA at Nanyang City Central Hospital between January 2022 and August 2023 were selected and randomly assigned to either the study group(n=30)or the control group(n=30)using a randomized numerical table.The control group underwent LMGA,while the study group underwent LPB composite LMGA.The perioperative indexes,pain level,hemodynamics,cognitive function,and occurrence of adverse events were then compared between the two groups.Results The onset of anesthesia,extubation time,awakening time,time to get out of bed,and hospital stay were shorter in the study group than in the control group.These differences were statistically significant(P<0.05).The visual analog scores(VAS)of the two groups decreased at 6 h,12 h,and 24 h postoperatively compared with those of the control group.Two hours postoperatively,the VAS scores of the study group were found to be lower than those of the control group at the same time period,with statistically significant differences(P<0.05).Additionally,the study group exhibited higher heart rates(HR)at the time of laryngeal mask insertion(T_(1)),skin incision(T_(2)),and implantation of prosthesis(T_(3)).The mean arterial pressure(MAP)at T_(2) was higher than that at T0,with statistically significant differences(P<0.05).Furthermore,the heart rate(HR)and MAP at T_(1),T_(2),T_(3),and the end of the operation(T_(4))in the study group were higher than that at T0,with statistically significant differences(P<0.05).Furthermore,HR and MAP at T_(1),T_(2),T_(3),and T_(4) were lower in the study group than in the control group,with a statistically significant difference(P<0.05).Additionally,the scores of the Mini-mental State Examination(MMSE)at 1 d and 3 d postoperatively in the two groups decreased compared with the preoperative scores.However,MMSE scores at the postoperative concurrent period were higher in the study group than in the control group,and the difference was statistically significant(P<0.05).Additionally,the incidence rate of adverse events in the study group(6.67%)was lower than that of the control group(30.00%),and the difference was statistically significant(P<0.05).Conclusion The LPB composite LMGA has been demonstrated to improve anesthesia,shorten awakening and hospitalization times,reduce pain levels,have less impact on hemodynamics and cognitive function,and reduce the occurrence of adverse events in elderly patients undergoing THA.