LPSB及CSEA麻醉方案用于老年髋部骨折术中的麻醉效果及患者血流动力学观察研究  

Lumbar plexus-sciatic nerve block and combined spinal-epidural anesthesia for elderly patients undergoing hip fracture surgery:anesthesia effect and impact on hemodynamics

作　　者：李声华 李冬 陈璟莉[1] 严虹[1] Li Shenghua;Li Dong;Chen Jingli;Yan Hong(Department of Anesthesiology,the Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,China)

机构地区：[1]华中科技大学同济医学院附属武汉中心医院麻醉科,武汉430014

出　　处：《中华临床医师杂志（电子版）》2021年第12期978-983,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的观察腰丛-坐骨神经阻滞麻醉(LPSB)及腰硬联合麻醉(CSEA)方案用于老年髋部骨折术中的麻醉效果及患者血流动力学的差异。方法选取2019年1月至2020年1月华中科技大学同济医学院附属武汉中心医院收治的共312例髋部骨折的老年患者作为研究对象,使用随机数表法将其分为观察组和对照组,每组各156例。所有患者均行髋关节置换术,观察组采用LPSB方案麻醉,对照组采用CSEA方案麻醉。记录2组麻醉效果相关指标[麻醉生效时间、感觉阻滞时间、苏醒时间、定向力恢复时间、运动能力恢复时间、拔管时间和视觉模拟疼痛评分(VAS)];记录2组麻醉前后6 h、12 h、24 h、48 h的简易智力状态检查量表(MMSE)评分;比较2组麻醉前后15 min、苏醒后15 min时的血流动力学指标[舒张压(DBP)、收缩压(SBP)、平均动脉压(MAP)、心率(HR)];观察并记录2组不良反应发生情况。结果与对照组相比,观察组麻醉生效时间、感觉阻滞时间较长,苏醒时间、定向力恢复时间、运动能力恢复时间、拔管时间较短,VAS评分较低,差异有统计学意义(P均<0.05)。麻醉后6 h、12 h、24 h、48 h,2组MMSE评分呈现先下降后上升的趋势,差异有统计学意义(P均<0.05);与对照组相比,观察组麻醉后6 h、12 h、24 h的MMSE评分较高,差异有统计学意义(P均<0.05)。从麻醉前到麻醉后15 min,2组DBP、SBP、MAP、HR水平呈现下降趋势;从麻醉后15 min到苏醒后15 min,各指标水平呈上升趋势,差异有统计学意义(P均<0.05);与对照组相比,观察组麻醉后15 min、苏醒后15 min各指标水平均较高,差异有统计学意义(P均<0.05)。手术后与对照组相比,观察组不良反应总发生率较低,差异有统计学意义(25.00%vs13.46%,P<0.05)。结论在老年髋关节手术中采用LPSB方案具有较好的麻醉效果,对患者认知功能和血流动力学影响较小,不良反应发生率较低,具有推广价值。ObjectiveTo observe the anesthetic effect of lumbar plexus-sciatic nerve block(LPSB)and combined spinal-epidural anesthesia(CSEA)and their impact on hemodynamics in elderly patients with hip fracture.MethodsA total of 312 elderly patients with hip fracture admitted to Wuhan Central Hospital affiliated to Tongji Medical College,Huazhong University of Science and Technology from January 2019 to January 2020 were selected as the research subjects.The patients were divided into an observation group and a control group by the random number table method,with 156 cases in each group.All patients underwent hip replacement;the observation group underwent LPSB for anesthesia,and the control group underwent CSEA.Indexes related to anesthesia effect were recorded in both groups,including time to effective anesthesia,time to sensory block,time to awakening,time to orientation recovery,time to recovery of motor function,time to extubation,and visual analogue scale(VAS)score.The scores of mini mental state examination(MMSE)before anesthesia and 6 h,12 h,24 h,and 48 h after anesthesia were recorded.Hemodynamic indexes[diastolic blood pressure(DBP),systolic blood pressure(SBP),mean arterial pressure(MAP),and heart rate(HR)]were compared between the two groups before anesthesia,15 min after anesthesia,and 15 min after recovery.The adverse reactions of the two groups were observed and recorded.ResultsCompared with the control group,time to effective anesthesia and time to sensory block were significantly longer,time to awakening,time to orientation recovery,time to motor function recovery,and time to extubation were significantly shorter,and the VAS score was significantly lower in the observation group(P<0.05 each).At 6 h,12 h,24 h,and 48 h after anesthesia,the MMSE scores of the two groups showed a trend of decrease first and then increase;the difference was statistically significant(P<0.05 each).Compared with the control group,the MMSE scores of the observation group at 6 h,12 h,and 24 h after anesthesia were significantly highe

关 键 词：老年 髋关节手术 腰丛-坐骨神经阻滞麻醉 腰硬联合麻醉 血流动力学 

分 类 号：R61[医药卫生—外科学]