比较神经阻滞与腰-硬联合麻醉对老年腹股沟斜疝患者术中血流动力学的影响

Comparative study of nerve block and spinal-epidural combined anesthesia on hemodynamic parameters in elderly patients with indirect inguinal hernia

目的比较神经阻滞与腰-硬联合麻醉对老年腹股沟斜疝患者术中血流动力学指标等的影响。方法选取2016年5月至2018年5月,湖南中医药大学第一附属医院86例老年腹股沟斜疝患者的临床资料,按照麻醉方式不同分为腰-硬联合组(43例)和神经阻滞组(43例)。所有患者均接受择期手术治疗,腰-硬联合组患者予以布比卡因进行腰-硬联合麻醉,神经阻滞组患者则于超声指导下予以罗哌卡因及右美托咪定进行神经阻滞。观测并比较2组患者的血流动力学指标、麻醉效果和不良反应发生率。结果 2组患者在各时间点的平均动脉压、呼吸频率及血氧饱和度血压水平比较,差异无统计学意义(P>0.05)。切皮(T1)时神经阻滞组心率较腰-硬联合组明显降低,差异有统计学意义(P<0.05);但其余时间2组患者HR比较,差异无统计学意义(P>0.05)。神经阻滞组的切皮时视觉模拟评分均显著低于腰-硬联合组,而神经阻滞组的感觉阻滞持续时间和Ramsay镇静评分均显著高于腰-硬联合组,但腰-硬联合组的感觉阻滞起效时间较神经阻滞组要短,差异均有统计学意义(P<0.05)。治疗后,神经阻滞组的不良反应发生率(6.98%)显著低于腰-硬联合组(23.36%),差异有统计学意义(P<0.05)。结论老年腹股沟斜疝患者在手术治疗过程中,神经阻滞较腰-硬联合麻醉的麻醉效果要好,可产生较好的镇痛、镇静作用,不良反应发生率较小,值得临床推广应用。

Objective To compare the effects of nerve block and spinal-epidural combined anesthesia on hemodynamic parameters in elderly patients with indirect inguinal hernia.Methods 86 elderly patients with indirect inguinal hernia treated in general surgery of First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from May 2016 to May 2018 were randomly divided into the spinal-epidural combined group(43 cases)and the nerve block group(43 cases).All patients received elective surgery.The spinal-epidural combined with bupivacaine was given to the patients in the spinal-epidural combined group.The nerve block group was given ropivacaine and dexmedetopyrimidine for nerve block under the guidance of ultrasound.Hemodynamic parameters,anesthetic effect and incidence of adverse reactions were compared between the two groups.Results There were no significant differences in the levels of MAP,RR and SPO2 between the two groups at different time points(P>0.05);the level of HR in the nerve block group at T1 was significantly lower than that in the spinal-epidural combined group(P<0.05),but there was no significant difference in the level of HR between the two groups at other time points(P>0.05).The score of VAS at skin incision in the nerve block group was significantly lower than that in the spinal-epidural group,while the sedation score of Ramsay and sensory block duration in the nerve block group was significantly higher than those in the spinal-epidural group,but the onset time of sensory block in the spinal-epidural combined group was shorter than that in the nerve block group.(P<0.05).After treatment,the incidence of adverse reactions in the nerve block group(6.98%)was significantly lower than that in the spinal-epidural combined group(23.36%)(P<0.05).Conclusion Nerve block is better than spinal-epidural combined anesthesia in elderly patients with indirect inguinal hernia.It can significantly produce better analgesic and sedative effects,and the incidence of adverse reactions is small,which is worthy of clinical promotion and application.