超声引导髂筋膜间隙阻滞复合全麻对高龄全髋关节置换术患者应激反应及麻醉苏醒的影响

Effects of Ultrasound-Guided Iliac Fascia Space Block Combined with General Anesthesia on Stress Response and Anesthesia Recovery in Elderly Patients Undergoing Total Hip Arthroplasty

目的探讨超声引导髂筋膜间隙阻滞复合全麻对高龄全髋关节置换术患者应激反应及麻醉苏醒的影响。方法选择2021年6月—2023年5月于金乡县人民医院行全髋关节置换术的100例高龄患者为研究对象,随机数表法将其分为对照组及观察组,每组50例。对照组行单纯全麻,观察组行超声引导髂筋膜间隙阻滞复合全麻。比较两组患者的血流动力学、应激反应、麻醉苏醒情况及不良反应发生情况。结果入室前,两组的平均动脉压(MAP)、心率比较,组间差异无统计学意义(P>0.05);术毕,观察组的MAP、心率与入室前比较,差异无统计学意义(P>0.05),但均高于对照组,组间差异有统计学意义(P<0.05)。入室前,两组的儿茶酚胺(CA)、乳酸(LAC)、皮质醇(Cor)水平比较,组间差异无统计学意义(P>0.05);术毕,观察组的CA、LAC、Cor水平均升高,但均低于对照组,差异有统计学意义(P<0.05)。观察组的自主呼吸恢复时间、呼之睁眼时间、定向力恢复时间分别为(11.89±1.76)min、(12.88±1.74)min、(14.52±1.74)min,均短于对照组的(13.18±1.88)min、(14.43±1.85)min、(16.14±1.75)min,组间差异有统计学意义(P<0.05)。两组的不良反应发生率比较,差异无统计学意义(P>0.05)。结论超声引导髂筋膜间隙阻滞复合全麻对高龄全髋关节置换术患者血流动力学的影响较小,利于减小应激反应,缩短其麻醉苏醒时间。

Objective To investigate the effects of ultrasound-guided iliac fascia space block combined with general anesthesia on stress response and anesthesia recovery in elderly patients undergoing total hip arthroplasty.Methods A total of 100 elderly patients who underwent total hip arthroplasty in Jinxiang County People's Hospital from June 2021 to May 2023 were selected as the study objects,and were divided into a control group and an observation group by random number table method,with 50 cases in each group.The control group received simple general anesthesia,and the observation group received ultrasound-guided iliac fascia space block combined general anesthesia.The hemodynamics,stress response,anesthesia recovery and adverse reactions were compared between the two groups.Results Before entering the operating room,there were no significant differences in mean arterial pressure(MAP)and heart rate between the two groups(P>0.05);after the operation,the MAP and heart rate of the observation group had no statistical significances compared with those before admission(P>0.05),but they were higher than those of the control group,and the differences between the groups were statistically significant(P<0.05).Before entering the operating room,there were no significant differences in the catecholamine(CA),lactic acid(LAC)and cortisol(Cor)levels between the two groups(P>0.05);after the operation,the levels of CA,LAC and Cor in the observation group were all increased,but they were all lower than those in the control group,and the differences between the groups were statistically significant(P<0.05).The recovery time of spontaneous respiration,eye opening time and orientation in the observation group were(11.89±1.76)min,(12.88±1.74)min and(14.52±1.74)min,respectively,which were shorter than(13.18±1.88)min,(14.43±1.85)min and(16.14±1.75)min in the control group,and the differences between the groups were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Ultrasound-guided iliac fascia space block combined with general anesthesia has little effect on hemodynamics in elderly patients with total hip arthroplasty,which is beneficial to reduce stress response and shorten the time of anesthesia recovery.