超声引导神经阻滞联合丙泊酚靶控输注对高龄髋关节手术患者镇静效果及血凝状态的影响

Influence of ultrasound-guided nerve block combined with propofol targetcontrolled infusion on sedative effect and coagulation status in elderly patients undergoing hip joint surgery

目的探讨超声引导神经阻滞联合丙泊酚靶控输注在高龄髋关节手术患者中对镇静效果及血凝状态的影响。方法选取2020年3月~2023年3月南通市第三人民医院骨科收治的90例高龄髋关节手术患者为研究对象,按随机数表法分为联合组、对照组,每组各45例。联合组采用超声引导下腰骶丛神经阻滞联合丙泊酚靶控输注进行麻醉,对照组仅给予丙泊酚靶控输注。比较两组患者手术中不同时间点的血流动力学指标[心率(heart rate,HR)和平均动脉压(mean arterial pressure,MAP)]、镇静效果[Richmond躁动-镇静评分(Richmond Agitation-Sedation Scale,RASS)、脑电双频指数(bispectral index,BIS)]、凝血指标[凝血酶时间(thrombin time,TT)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)]以及不良反应发生率。结果在麻醉药注射10 min后、气管插管时,联合组的HR明显低于对照组,在麻醉药注射10 min后至手术结束时联合组的MAP均低于对照组(P<0.05);在麻醉药注射10 min后至手术结束时,联合组的RASS和BIS均低于对照组(P<0.05);在手术结束时的TT、PT、APTT均高于麻醉前,且联合组明显高于对照组(P<0.05);联合组在术中心律失常和术后呕吐的发生率显著低于对照组,差异有统计学意义(P<0.05)。结论超声引导神经阻滞联合丙泊酚靶控输注在高龄髋关节手术患者中可有效改善血流动力学稳定性、增强镇静效果,并保持患者的血凝状态更为稳定,提高安全性,值得在临床中推广使用。

Objective To investigate the impact of ultrasound-guided nerve block combined with propofol target-controlled infusion on the sedative effect and coagulation status in elderly patients undergoing hip joint surgery.Methods Ninty elderly patients undergoing hip joint surgery at the Third People’s Hospital of Nantong from March 2020 to March 2023 were select⁃ed.They were divided into combined group and control group using random number table meth⁃od,with 45 patients in each group.The combined group received anesthesia through ultra⁃sound⁃guided lumbosacral plexus nerve block combined with propofol target⁃controlled infusion,while the control group only received propofol target⁃controlled infusion.The hemodynamic in⁃dices[heart rate(HR)and mean arterial pressure(MAP)],sedative effects[Richmond Agita⁃tion⁃Sedation Scale(RASS)and bispectral index(BIS)],coagulation indices[thrombin time(TT),prothrombin time(PT),and activated partial thromboplastin time(APTT)],and ad⁃verse reaction rates of patients in both groups at different time points during the surgery were compared.Results Ten minutes after the injection of anesthetic drugs and during intubation,the HR of the combined group was significantly lower than that of the control group.From 10 mintues after injection of the anesthetic drug to the end of the surgery,the MAP of the com⁃bined group was consistently lower than that of the control group(P<0.05).Also,during this period,the RASS and BIS scores of the combined group were lower than those of the control group(P<0.05).At the end of the surgery,TT,PT and APTT were all higher than before anesthesia,and these indices were notably higher in the combined group than in the control group(P<0.05).The incidence of intraoperative arrhythmia and postoperative vomiting in the combined group was significantly lower than in the control group(P<0.05).Conclusion Ultrasound⁃guided nerve block combined with propofol target⁃controlled infusion can effectively enhance hemodynamic stability,improve sedation,and maintain a more stable coagulation sta⁃tus in elderly patients undergoing hip joint surgery.This method enhances patient safety and is worth promoting in clinical practice.