摘要
目的探讨超声引导下腰骶丛神经阻滞联合全身麻醉在髋关节置换术中的应用价值。方法选取2017年4月至2020年1月于广州中医药大学第一附属医院实施髋关节置换术的患者110例作为研究对象,采用随机数字表法将其分为研究组和对照组,每组各55例。对照组患者采用全身麻醉实施手术,研究组患者采用超声引导下腰骶丛神经阻滞联合全身麻醉实施手术;比较两组患者围术期血流动力学参数、氧化应激反应指标变化,以及术中麻醉药物用量、术后拔管时间、下床活动时间、住院天数、麻醉相关不良反应发生率。结果研究组患者平均动脉压在麻醉诱导即刻、麻醉诱导后30 min均显著高于同期对照组(均P<0.05),在拔管即刻显著低于同期对照组(P<0.05);研究组患者心率在拔管即刻显著低于同期对照组(P<0.05)。术前,两组患者血清白介素-6、血糖、皮质醇、丙二醛、肿瘤坏死因子-α水平比较差异均无统计学意义(均P>0.05),术后4 h,研究组患者以上指标均显著低于对照组(均P<0.05)。研究组患者术中舒芬太尼用量显著低于对照组(P<0.05),术后拔管时间显著短于对照组(P<0.05),两组患者下床活动时间、住院天数比较差异均无统计学意义(均P>0.05)。研究组患者不良反应发生率显著低于对照组(P<0.05)。结论在髋关节置换术中,与单纯全身麻醉相比,超声引导下腰骶丛神经阻滞联合全身麻醉更有利于维持术中血流动力学稳定、减少术中舒芬太尼用量及降低麻醉不良反应发生率。
Objective To investigate the value of ultrasound-guided lumbosacral plexus block combined with general anesthesia in hip arthroplasty.Method A total of 110 patients underwent hip arthroplasty in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from April 2017 to January 2020 were selected as the research subjects.They were divided into study group and control group by random number table method,with 55 patients in each group.Patients in control group were operated under general anesthesia,and patients in study group were operated under ultrasound-guided lumbosacral plexus block combined with general anesthesia.The changes of perioperative hemodynamic parameters,oxidative stress response indexes,intraoperative anesthetic drug dosage,postoperative extubation time,activity time out of bed,hospital stay,and incidence of anaesthetic-related adverse reactions were compared between the two groups.Result The mean arterial pressure in study group was significantly higher than that in control group immediately after anesthesia induction and 30 min after anesthesia induction(all P<0.05),and was significantly lower than that in control group immediately after extubation(P<0.05).The heart rate in study group was significantly lower than that in control group immediately after extubation(P<0.05).Before surgery,there were no statistically significant differences in serum levels of interleukin-6,blood glucose,cortisol,malondialdehyde and tumor necrosis factor-αbetween the two groups(all P>0.05),and 4 h after surgery,the above indexes in study group were significantly lower than those in control group(all P<0.05).The dosage of sufentanil in study group was significantly lower than that in control group(P<0.05),and the postoperative extubation time was significantly shorter than that in control group(P<0.05).There was no statistical significance in activity time out of bed and hospital stay between the two groups(all P>0.05).The incidence of adverse reactions in study group was significantly lower than that in control group(P<0.05).Conclusion Compared with general anesthesia alone,ultrasound-guided lumbosacral plexus block combined with general anesthesia is more beneficial to maintain intraoperative hemodynamic stability,reduce intraoperative sufentanil dosage and the incidence of adverse reactions to anesthesia during hip arthroplasty.
作者
庄凯峰
吴财能
马武华
Zhuang Kaifeng;Wu Caineng;Ma Wuhua(Department of Anesthesiology,the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou 510405,China)
出处
《中国医学前沿杂志（电子版）》
2021年第5期56-60,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
广东省科学技术厅自筹经费类科技计划项目(2017ZC0155)。
关键词
超声引导
腰骶丛神经阻滞
髋关节置换术
全身麻醉
Ultrasound guidance
Lumbosacral plexus block
Hip replacement surgery
General anesthesia
