超声引导下前路腰丛联合臀上皮神经阻滞在老年人髋关节置换手术中的临床应用  

The clinical application of ultra-sound guided anterior lumbar plexus combined with buttock epithelial nerve block on elderly patients undergoing hip replacement surgery

作　　者：罗方毅 喻旭娇 樊雅玲[1] 黄斌 Luo Fangyi;Yu Xujiao;Fan Yaling;Huang Bin(Department of Anesthesiology, the People’s Hospital of Leshan, Leshan 614000, China)

机构地区：[1]乐山市人民医院麻醉科,614000

出　　处：《国际麻醉学与复苏杂志》2019年第7期636-639,共4页International Journal of Anesthesiology and Resuscitation

基　　金：四川省医学科研青年创新课题计划(Q16034).

摘　　要：目的 探讨超声引导下前路腰丛联合臀上皮神经阻滞在老年髋关节置换手术中的应用。 方法 择期行单侧髋关节置换术的老年患者60例,采用随机数字表法分为两组(每组30例):前路腰丛联合臀上皮神经阻滞组(A组),超声引导下实施前路腰丛阻滞组(B组)。两组均采用浅全身麻醉复以喉罩通气。术中两组均维持BIS45~55,记录入室时(T0)、切皮时(T1)、缝皮时(T2)、拔喉罩前(T3)的心率、血压,术中舒芬太尼用量,术后拔管时间,术后1、6、12、24hVAS评分及首次下床活动时间。 结果 A组患者在T1、T2、T3时点心率和MAP明显低于B组(P<0.05),A组术中使用舒芬太尼的量明显低于B组(P<0.05),术后拔管时间、首次下床活动时间均短于B组(P<0.05),A组患者术后1、6、12hVAS评分均明显低于B组(P<0.05)。 结论 与前路腰丛阻滞比较,联合臀上皮神经阻滞应用于老年髋关节置换手术中,可维持术中循环更稳定,明显减少术中阿片类药物的用量及术后拔喉罩时间,术后早期镇痛效果更好,可以缩短首次下床时间。Objective To observe the clinical application of ultra-sound guided anterior lumbar plexus combined with buttock epithelial nerve block on elderly patients undergoing hip replacement surgery. Methods Sixty elderly patients (range from 60 to 80 years old) scheduled for unilateral hip replacement surgery were randomly divided to anterior lumbar plexus combined with buttock epithelial nerve block group (group A) and anterior lumbar plexus nerve block group (group B) by random number table method. The airways of all the patients were controlled by laryngeal mask airway (LMA) in both groups. The bispectral index (BIS) of patients in both groups was maintained in the range of 45-55. The heart rate, systolic and diastolic blood pressure when cutting were recorded respectively. The dosage of sulfentanyl, Visual Analogue Scale (VAS) score at 1, 6, 12 h and 24 h after surgery were recorded. The period from end of surgery to extubation, first off-bed activity after surgery were evaluated. Results The heart rate and blood pressure of patients in group A were less than those indexes of patients in group B at T1, T2, T3 (P<0.05). The averaged dosage using of sulfentanyl of group A was less than the dosage of group B (P<0.05). The periods from end of surgery to extubation and off-bed activity of group A were shorter than the periods in group B (P<0.05). The VAS scores at 1, 6, 12 h after surgery in group A were lower than those scores in group B (P<0.05). Conclusions Compared with anterior lumbar plexus nerve block, ultra-sound guided anterior lumbar plexus combined with buttock epithelial nerve block could help maintain circulation stability, reduce usage of opioids during operation, shorten the period of off-bed activity and the period from end of surgery to extubation and offer better analgesia effect on elderly patients undergoing hip replacement surgery.

关 键 词：臀上皮神经阻滞 超声引导 前路腰丛阻滞 髋关节置换 老年人 

分 类 号：R614[医药卫生—麻醉学]