[1]黄 海,刘玉杰,刘慧杰,等.超声引导下前路髂腰肌间隙阻滞联合侧路骶丛阻滞对老年髋关节置换手术镇痛效果及应激呼吸循环的影响[J].医学信息,2023,36(12):112-115.[doi:10.3969/j.issn.1006-1959.2023.12.021]
　HUANG Hai,LIU Yu-jie,LIU Hui-jie,et al.Effect of Ultrasound-guided Anterior Iliopsoas Space Block Combined with Lateral Sacral Plexus Block on Analgesic Effect and Stress Respiratory Circulation in Elderly Patients Undergoing Hip Replacement Surgery[J].Journal of Medical Information,2023,36(12):112-115.[doi:10.3969/j.issn.1006-1959.2023.12.021]
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超声引导下前路髂腰肌间隙阻滞联合侧路骶丛阻滞对老年髋关节置换手术镇痛效果及应激呼吸循环的影响()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年12期
页码:
112-115
栏目:
论著
出版日期:
2023-06-15

文章信息/Info

Title:
Effect of Ultrasound-guided Anterior Iliopsoas Space Block Combined with Lateral Sacral Plexus Block on Analgesic Effect and Stress Respiratory Circulation in Elderly Patients Undergoing Hip Replacement Surgery
文章编号:
1006-1959（2023）12-0112-04
作者:
黄 海; 刘玉杰; 刘慧杰; 等
（天津中医药大学第二附属医院麻醉科，天津 300250）
Author(s):
HUANG Hai; LIU Yu-jie; LIU Hui-jie; et al.
(Department of Anesthesiology,Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300250,China)
关键词:
超声引导; 前路髂腰肌间隙阻滞; 侧路骶丛阻滞; 髋关节置换; 镇痛
Keywords:
Ultrasound-guided; Anterior iliopsoas space block; Lateral sacral plexus block; Hip replacement; Analgesia
分类号:
R614
DOI:
10.3969/j.issn.1006-1959.2023.12.021
文献标志码:
A
摘要:
目的 研究超声引导下前路髂腰肌间隙阻滞联合侧路骶丛阻滞对老年髋关节置换手术镇痛效果及应激呼吸循环的影响。方法 选取2019年6月-2022年6月在我院行髋关节置换手术的104例老年患者为研究对象，采用随机数字表法分为对照组和观察组，各52例。对照组采用全麻，观察组采用超声引导下前路髂腰肌间隙阻滞联合侧路骶丛阻滞，比较两组不同时间点心率（HR）、血压[收缩压（SBP）、舒张压（DBP）]、血氧饱和度（SpO2）以及呼吸频率（RR）水平、术后不同时间段疼痛评分、麻醉起效时间、首次下床活动时间、不同时间点认知功能评分、不良反应发生率。结果 与T0时刻比较，T1、T2、T3时间段SBP、DBP、HR、RR均有不同程度的下降，HR均有不同程度升高，且观察组SBP、DBP、HR、RR低于对照组，HR高于对照组（P＜0.05）；观察组T4与T0时间段各指标比较，差异无统计学意义（P＞0.05），对照组T4时间段各指标均低于T0（P＜0.05）；观察组术后1、6、12 h疼痛评分均低于对照组（P＜0.05），24、48 h疼痛评分与对照组比较，差异无统计学意义（P＞0.05）；观察组麻醉起效时间、首次下床活动时间均小于对照组（P＜0.05）；术后2、6 h认知功能评分均低于术前，但观察组高于对照组（P＜0.05），术后24 h认知功能评分与术前比较，差异无统计学意义（P＞0.05）；观察组不良反应发生率为7.69%，低于对照组的19.23%（P＜0.05）。结论 在老年髋关节置换术中采用超声引导下前路髂腰肌间隙阻滞联合侧路骶丛阻滞麻醉，临床镇痛效果确切，对呼吸循环、生命体征、认知功能影响较小，是一种安全、有效的麻醉方式。
Abstract:
Objective To study the effect of ultrasound-guided anterior iliopsoas space block combined with lateral sacral plexus block on analgesia and stress respiration and circulation in elderly patients undergoing hip replacement.Methods A total of 104 elderly patients who underwent hip replacement surgery in our hospital from June 2019 to June 2022 were selected as the research objects. They were divided into control group and observation group by random number table method, with 52 patients in each group. The control group was treated with general anesthesia, and the observation group was treated with ultrasound-guided anterior iliopsoas space block combined with lateral sacral plexus block. The heart rate (HR), blood pressure [systolic blood pressure (SBP), diastolic blood pressure (DBP)], blood oxygen saturation (SpO2) and respiratory rate (RR) levels at different time points, pain scores at different time points after surgery, onset time of anesthesia, first time to get out of bed, cognitive function scores at different time points, and incidence of adverse reactions were compared between the two groups.Results Compared with T0, SBP, DBP, HR and RR at T1, T2 and T3 decreased to varying degrees, and HR increased to varying degrees, while SBP, DBP, HR and RR in the observation group were lower than those in the control group, and HR was higher than that in the control group (P<0.05). There was no significant difference in the indexes between T4 and T0 in the observation group (P>0.05), but the indexes of T4 in the control group were lower than those of T0 (P<0.05). The pain scores at 1, 6 and 12 h after operation in the observation group were lower than those in the control group (P<0.05), and there was no significant difference in pain scores at 24 and 48 h after operation between the two groups (P>0.05). The onset time of anesthesia and the time of first ambulation in the observation group were less than those in the control group (P<0.05). The cognitive function score at 2 and 6 h after operation was lower than that before operation, but that in the observation group was higher than that in the control group (P<0.05). There was no significant difference in cognitive function score between 24 h after operation and before operation (P>0.05). The incidence of adverse reactions in the observation group was 7.69%, which was lower than 19.23% in the control group (P<0.05).Conclusion Ultrasound-guided anterior iliopsoas space block combined with lateral sacral plexus block anesthesia in elderly hip replacement has a definite clinical analgesic effect, and has little effect on respiratory circulation, vital signs and cognitive function. It is a safe and effective anesthesia method.

参考文献/References:

[1]朱涛.右美托咪定对全麻下老年髋关节置换术患者认知功能的影响[J].浙江创伤外科,2019,24(5):1029-1030.[2]张宪宦,田晓涛,韩景田,等.超声引导下神经阻滞对老年髋关节置换术患者的循环系统及苏醒质量的观察[J].贵州医药,2018,42(12):1457-1458.[3]Memtsoudis SG,Poeran J, Cozowicz C,et al.The impact of peripheral nerve blocks on perioperative outcome in hip and knee arthroplasty-a population-based study[J].Pain,2016,157(10):2341-2349.[4]张曙报,顾尔伟,王靖宇,等.3种麻醉方式对老年髋关节置换手术患者术后转归的影响[J].安徽医科大学学报,2016,51(7):1062-1066.[5]任益锋,石薇,陈程哲,等.纳布啡联合右美托咪定用于乳腺癌切口局部浸润镇痛的临床研究[J].中国疼痛医学杂志,2019,25(12):941-945.[6]胡超力,李成,王芬,等.腰骶丛神经阻滞与髂筋膜间隙阻滞在全髋关节置换术中镇痛效果比较[J].同济大学学报(医学版),2018,39(3):99-103.[7]王志广,金海飞,朱丽娜,等.全身麻醉结合髂筋膜间隙阻滞对髋关节置换术后疼痛及炎症应激介质分泌的影响[J].浙江创伤外科,2019,24(1):204-206.[8]张炳勇,高涛.超声引导下行髂筋膜联合腰骶丛神经阻滞和全身麻醉在老年患者髋关节置换术中的对比研究[J].中华老年多器官疾病杂志,2019,18(9):688-692.[9]中华医学会麻醉学分会老年人麻醉学组,中华医学会麻醉学分会骨科麻醉学组.中国老年髋部骨折患者麻醉及围术期管理指导意见[J].中华医学杂志,2017,97(12):897-905.[10]赖尚导,陈伟元,谌业光,等.3种麻醉方式在老年髋部骨折手术治疗中的应用效果[J].临床骨科杂志,2019,22(6):708-711.[11]王静.左旋布比卡因椎管内麻醉在老年全髋关节置换术中的应用价值分析[J].四川解剖学杂志,2018,26(2):48-50.[12]刘刚,王如意,于泳浩,等.氢气吸入对老年患者髋部骨折术后谵妄的影响[J].临床麻醉学杂志,2018,34(7):643-646.[13]刘磊,彭敏,陈涛.七氟醚静吸复合麻醉与全凭静脉麻醉对高龄患者髋关节置换手术后早期认知功能的影响比较[J].临床外科杂志,2018,26(2):142-144.[14]夏勇军,白永峰,雷茜,等.不同剂量右美托咪定对髋关节置换术老年高血压患者术后谵妄的影响[J].国际麻醉学与复苏杂志,2016,37(3):225-229.[15]邹高锐,范钧钊,封享兰,等.七氟醚吸入麻醉联合腰骶丛神经阻滞用于老年患者髋关节置换术的优势评估[J].中华麻醉学杂志,2017,37(10):1180-1183.[16]曾宗诚,郭锦翠,邹华章.腰硬联合麻醉用于高龄髋关节置换术的效果及对心脏氧耗二联指数、血氧饱和度的影响[J].广东医学,2019,40(1):286-288.

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更新日期/Last Update: 1900-01-01