超声引导下腰骶神经丛阻滞联合臀上皮神经阻滞对老年髋关节置换术患者镇痛和术后恢复的影响

Effect of Ultrasound-guided Lumbosacral Plexus Block Combined with Superior Gluteal Nerve Block on Analgesia and Postoperative Recovery in Elderly Patients Undergoing Hip Replacement

目的:探讨超声引导下腰骶神经丛阻滞联合臀上皮神经阻滞对老年髋关节置换术(THA)患者镇痛和术后恢复的影响。方法:选取2023年4月—2024年4月福建省漳州市医院收治的80例THA老年患者作为研究对象,按照随机数表法分为对照组和观察组,每组各40例。两组均给予静吸复合全身麻醉以喉罩通气治疗,对照组给予超声引导下腰骶神经丛阻滞干预,观察组给予超声引导下腰骶神经丛阻滞+臀上皮神经阻滞干预。比较两组入室时(T0)、切皮时(T1)、切皮后30 min(T2)、缝皮时(T3)及拔喉罩前(T4)的心率(HR)、收缩压(SBP)及舒张压(DBP),两组术前及术后2 h、4 h、12 h、24 h及48 h疼痛情况[视觉模拟疼痛评分(VAS)];比较两组术后恢复情况麻醉复苏室(PACU)停滞时间、静脉阵痛(PCIA)使用次数、术后首次进食时间及术后首次下床活动时间]及术后48 h不良反应情况。结果:观察组T1、T2、T3及T4时HR、SBP及DBP均低于对照组,差异有统计学意义(P<0.05)。术后,观察组2 h、4 h、12 h及24 hVAS评分均低于对照组,差异有统计学意义(P<0.05);两组48 hVAS评分比较,差异无统计学意义(P>0.05)。观察组PCIA使用次数少于对照组,差异有统计学意义(P<0.05);观察组术后首次进食时间及术后首次下床活动时间均短于对照组,差异有统计学意义(P<0.05);两组PACU停滞时间比较,差异无统计学意义(P>0.05)。两组不良反应发生比较,差异无统计学意义(P>0.05)。结论:在老年THA患者中实施超声引导下腰骶神经丛阻滞联合臀上皮神经阻滞能提供更稳定的心率与血压,围术期镇痛效果明确,且能缩短患者术后恢复时间。

Objective:To investigate the effect of ultrasound-guided lumbosacral plexus block combined with superior gluteal nerve block on analgesia and postoperative recovery in elderly patients undergoing total hip arthroplasty(THA).Method:A total of 80 elderly patients who underwent THA in Zhangzhou Hospital hospital from April 2023 to April 2024 were selected as the study objects and divided into control group and observation group according to the random number table method,with 40 cases in each group.Both groups were given shallow general anesthesia with laryngeal mask ventilation,and the control group was given ultrasound-guided lumbosacral plexus block,the observation group was given ultrasound-guided lumbosacral plexus block and gluteal epithelial nerve block.The heart rate(HR),systolic blood pressure(SBP)and diastolic blood pressure(DBP)were compared between the two groups at the time of entering the room(T0),skin incision(T1),30 min after skin incision(T2),skin suture(T3)and before laryngeal mask extraction(T4).The pain[visual analogue pain score(VAS)]was compared between the two groups before and after operation 2 h,4 h,12 h,24 h and 48 h after operation.The postoperative recovery[postanesthesia care unit(PACU)stagnation time,intravenous analgesia(PCIA)use times,postoperative first feeding time and postoperative first ambulation time]and adverse reactions 48 h after operation were compared between the two groups.Result:HR,SBP and DBP at T1,T2,T3 and T4 in the observation group were lower than those in the control group,the difference was statistically significant(P<0.05).The VAS scores of the observation group were lower than those of the control group 2 h,4 h,12 h and 24 h after operation(P<0.05).There was no difference in VAS scores between the two groups 48 h after operation(P>0.05).The number of PCIA use in the observation group was less than that in the control group(P<0.05).The time of first eating and first ambulation in the observation group after operation was shorter than that in the control group(P<0.05).There was no significant difference in PACU stagnation time between the two groups(P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Ultrasound-guided lumbosacral plexus block combined with gluteal epithelial nerve block in older patients with THA provides more stable heart rate and blood pressure,clear perioperative analgesic effect,and can shorten the postoperative recovery time of patients.