超声引导下髂筋膜及骶丛神经阻滞复合全身麻醉在老年患者髋关节置换术中的效果评价

Plexus Block Combined with General Anesthesia in Elderly Patients Un⁃dergoing Hip Replacement

目的分析超声引导下髂筋膜及骶丛神经阻滞复合全身麻醉在老年患者髋关节置换术中的效果。方法回顾性选取2022年12月—2024年5月江苏省南通市启东中医院收治的85例老年髋关节置换术患者的临床资料。根据麻醉方法不同分为观察组(43例,超声引导下髂筋膜及骶丛神经阻滞复合全身麻醉)和对照组(42例,全身麻醉)。比较两组血流动力学指标、术后疼痛评分、术后24 h内自控镇痛用按压次数和认知功能。结果麻醉诱导前5 min,两组心率和平均动脉压比较,差异无统计学意义(P均>0.05);麻醉10 min和术毕时,观察组心率和平均动脉压均低于对照组,差异有统计学意义(P均<0.05)。观察组术后6 h、12 h、24 h的视觉模拟评分法评分均低于对照组,差异有统计学意义(P均<0.05)。观察组术后24 h内自控镇痛用按压次数为(4.25±0.45)次,低于对照组的(6.03±0.89)次,差异有统计学意义(t=11.677,P<0.05)。观察组患者术后6 h、12 h、24 h的简易智能状态检查量表评分均高于对照组,差异有统计学意义(P均<0.05)。结论超声引导下髂筋膜及骶丛神经阻滞复合全身麻醉在老年患者髋关节置换术中的效果较好,能改善患者的认知功能,其术后恢复较快,血流动力学指标更稳定,能进一步减轻患者的术后疼痛。

Objective To analyze the effect of ultrasound-guided iliac fascia and sacral plexus block combined with general anesthesia in elderly patients undergoing hip replacement.Methods The clinical data of 85 elderly patients with hip replacement admitted to Qidong Hospital of Traditional Chinese Medicine in Nantong City of Jiangsu Prov⁃ince from December 2022 to May 2024 were retrospectively selected.According to different anesthesia methods,they were divided into observation group(43 cases,ultrasound-guided iliac fascia and sacral plexus block combined with general anesthesia)and control group(42 cases,general anesthesia).The hemodynamic indexes,postoperative pain score,number of patient-controlled analgesia presses within 24 h after operation and cognitive function were com⁃pared between the two groups.Results At 5 min before anesthesia induction,there were no significant differences in heart rate and mean arterial pressure between the two groups(both P>0.05).At 10 min after anesthesia and at the end of operation,the heart rate and mean arterial pressure in the observation group were lower than those in the control group,and the differences were statistically significant(all P<0.05).The Visual Analogue Scale scores of the observa⁃tion group at 6 h,12 h and 24 h after operation were lower than those of the control group,and the differences were statistically significant(all P<0.05).The number of patient-controlled analgesia presses within 24 h after operation in the observation group was(4.25±0.45)times,which was lower than(6.03±0.89)times in the control group,and the dif⁃ference was statistically significant(t=11.677,P<0.05).The scores of Mini-mental State Examination at 6 h,12 h and 24 h after operation in the observation group were higher than those in the control group,and the differences were sta⁃tistically significant(all P<0.05).Conclusion Ultrasound-guided iliac fascia and sacral plexus block combined with general anesthesia has a good effect in hip replacement in elderly patients.It can improve the cognitive function of pa⁃tients,recover faster after operation,and have more stable hemodynamic indexes,which can further reduce the postop⁃erative pain of patients.