腰方肌阻滞联合腰硬联合麻醉在老年性髋关节手术中的应用研究  

Study on the Application of Combined Spinal and Epidural Anesthesia Combined with Quadratus Lumborum Block in Elderly Hip Joint Operation

作　　者：李靖 王淼 唐丽 齐敦益 羊黎晔[4] Li Jing;Wang Miao;Tang Li;Qi Dunyi;Yang Liye(Jiangsu Key Laboratory of Anesthesiology,Xuzhou Medical University,Xuzhou,Jiangsu,221004,P.R.China;Department of Anesthesiology,Wuxi Branch of Zhongda Hospital Affiliated to Southeast University(Wuxi Xishan People's Hospital),Wuxi,Jiangsu,214000,P.R.China;Department of Anesthesiology,Affiliated Hospital of XuzhouMedical University,Xuzhou,Jiangsu,221000,P.R.China;Department of Anesthesiology,Shanghai Changzheng Hospital,Shanghai,200003,P.R.China)

机构地区：[1]徐州医科大学江苏省麻醉学重点实验室,江苏徐州221004 [2]东南大学附属中大医院无锡分院(无锡市锡山人民医院)麻醉科,江苏无锡214000 [3]徐州医科大学附属医院麻醉科,江苏徐州221000 [4]上海长征医院麻醉科,上海200003

出　　处：《老年医学与保健》2020年第3期387-389,401,共4页Geriatrics & Health Care

基　　金：江苏省卫生健康委科研课题(H2018023)。

摘　　要：目的探究腰方肌阻滞联合腰硬联合麻醉对老年患者髋关节术后认知功能及血压的影响,为选择更优的麻醉方案提供参考依据。方法回顾性分析2018年7月-2019年12月在徐州医科大学无锡市锡山人民医院麻醉科行髋关节置换术的老年患者80例的临床资料,根据不同麻醉方式分为观察组和对照组,每组40例。对照组施行腰硬联合麻醉,观察组采用腰方肌阻滞联合腰硬联合麻醉。比较2组各时间段静息时VAS评分、不同时间段平均动脉压(mean arterial pressure,MAP)及MMSE和Ramsay评分情况。结果观察组术后各时间段静息时VAS评分均明显低于对照组(P<0.05);2组在术前、术中各时间段及术后2 h的MAP差异均无统计学意义(P>0.05);2组在手术结束时与术后第1天认知功能降低,但观察组患者认知功能明显优于对照组(P<0.05)。2组患者在术前与术后1周认知功能无明显差异。结论腰方肌阻滞联合腰硬联合麻醉具有良好的镇痛效果,减少患者的躁动,稳定患者的平均动脉压,降低术后认知障碍的发生率,具有一定的临床应用价值。Objective To explore the effect of lumbar quadratus block combined with spinal epidural anesthesia on cognitive function and blood pressure in elderly patients after hip joint operation,and to provide clinical reference for choosing better anesthesia schemes.Methods 80 elderly patients who underwent hip replacement from July 2018 to December 2019 were selected as the research subjects.According to the different anesthesia schemes,they were divided into control group and observation group,40 cases in each group.The control group received combined spinal epidural anesthesia,and the observation group did lumbar quadratus block combined with spinal epidural anesthesia.VAS scores,mean arterial pressure(MAP),MMSE and Ramsay scores at various times were compared between the two groups.Results The VAS scores of the observation group at various time were significantly lower than those of the control group(P<0.05);There was no statistically significant difference in MAP between the two groups before and during the operation and at 2 hours after the operation(P>0.05);The cognitive function of the two groups decreased at the end of operation and the first day after operation,but the cognitive function of the observation group was significantly better than that of the control group(P<0.05).There was no significant difference in cognitive function between two groups before and 1 week after the operation.Conclusion The lumbar quadratus block combined with spinal epidural anesthesia has a good analgesic effect,which can reduce the restlessness of patients,stabilize the blood pressure of patients,reduce the incidence of post-operative cognitive dysfunction and has certain clinical application value.

关 键 词：老年 腰方肌阻滞 腰硬联合麻醉 髋关节置换术 认知功能 

分 类 号：R614[医药卫生—麻醉学]