摘要
目的探讨神经刺激仪引导下腰丛和坐骨神经联合阻滞对全髋关节置换的患者围术期血清肌钙蛋白及儿茶酚胺变化的影响。方法选择解放军第九一○医院2014年2月至2017年6月收治的需行单侧全髋关节置换术的患者68例,采用随机数字表法分为试验组和对照组,每组34例。试验组采用神经刺激仪引导下腰丛-坐骨神经阻滞复合喉罩全麻,对照组采用常规喉罩全麻,2组术后均行经静脉自控镇痛(PCIA),依次在麻醉前(T1)、拔管后半小时(T2)、术后4 h(T3)、8 h(T4)、24 h(T5)、48 h(T6)采集患者静脉血样,监测血清肌钙蛋白I(cTnI)水平,并于T3、术后第1天(T7)、第2天(T8)的清晨检测儿茶酚胺。记录T2、T3、T4、T5、T8的视觉模拟评分(VAS)。结果试验组的T3~T6的肌钙蛋白I和T3、T7、T8血清的儿茶酚胺均降低。T2、T3、T4、T5、T8试验组的VAS疼痛评分均明显小于对照组;试验组的VAS疼痛评分中,T2、T3、T4均较T1降低。结论神经刺激仪引导下腰丛和坐骨神经阻滞联合喉罩全麻用于全髋关节置换的患者,可有效降低血清肌钙蛋白水平及儿茶酚胺分泌,对维持老年患者的循环稳定及心肌保护起到重要的作用,缩短住院天数,有效地改善患者的短期预后。
Objective To investigate the effects of combined lumbar plexus and sciatic nerve block under the direction of nerve stimulator on serum troponin and catecholamine in patients undergoing total hip replacement during the perioperative period.Methods Sixty-eight patients undergoing unilateral total hip arthroplasty collected from the No.910 Hospital of CPLA were chosen from February 2014 to June 2017 for the study, and they were randomly divided into the experimental group and the control group, each consisting of 34 patients. Under the direction of nerve stimulator, the experiment group underwent lumbar plexus-sciatic nerve block combined with laryngeal mask anesthesia, while the control group just had conventional laryngeal mask anesthesia. After surgery, the patients of the 2 groups were all treated with PCIA. Venous blood samples were collected respectively at the following time points, just before anesthesia(T1), half an hour after extubation(T2), 4 hours after surgery(T3), 8 hours after surgery(T4), 24 hours after surgery(T5) and 48 hours after surgery(T6). The level of serum troponin I(cTnI) was detected, and the levels of catecholamines were detected at T3 and in the early morning of the first day(T7) and the second day(T8) after surgery. The visual analog scores(VAS) at T2, T3, T4, T5 and T8 were recorded.Results The troponin I levels in the experimental group at the time points of T3-T6 and serum catecholamines levels at T3, T7 and T8 were all decreased. The VAS scores of the experiment group at T2, T3, T4, T5 and T8 were significantly lower than those of the control group. The VAS scores of the experiment group at T2, T3 and T4 were all decreased, as compared with those detected at T1.Conclusion Nerve stimulator-guided lumbar plexus and sciatic nerve block combined with laryngeal mask anesthesia in the patients undergoing total hip replacement could effectively reduce the level of serum cardiac troponin and catecholamine secretion. It was of great importance in the maintenance of circulatory stability and myocardial protection in elderly patients. In addition, it could shorten hospitalization days and improve short-term prognosis of the patients.
作者
王少平
施志波
游仁芳
许培阳
Wang Shaoping;Shi Zhibo;You Renfang;Xu Peiyang(Department of Anesthesiology,No.910 Hospital,PLA,Quanzhou 362000,China)
出处
《海军医学杂志》
2019年第6期565-567,579,共4页
Journal of Navy Medicine
关键词
腰丛
坐骨神经
关节成形术
置换
髋
肌钙蛋白I
儿茶酚胺类
Lumbosacral plexus
Sciatic nerve
Arthroplasty
Replacement
Hip
Troponin I
Catecholamines
