腰椎旁神经阻滞联合全凭静脉全身麻醉对髋关节置换术患者血流动力学、应激反应、术后苏醒的影响  

Effects of Lumbar Paraspinal Nerve Block Combined with Total Intravenous General Anesthesia on Hemodynamics,Stress Response and Postoperative Recovery in Patients Undergoing Hip Replacement

作　　者：宋莉 董雪 王旭莉[1] 郭志华[1] SONG Li;DONG Xue;WANG Xu-li;GUO Zhi-hua(Department of Anesthesiology,the First Hospital of Fangshan District,Beijing 102400,China)

机构地区：[1]北京市房山区第一医院麻醉科,北京102400

出　　处：《临床误诊误治》2021年第2期69-73,共5页Clinical Misdiagnosis & Mistherapy

基　　金：北京市通州区科技计划项目(KJ2018CX009)。

摘　　要：目的观察腰椎旁神经阻滞联合全凭静脉全身麻醉对髋关节置换术患者血流动力学、应激反应、术后苏醒的影响。方法选取2018年1月—2019年8月我院收治的行髋关节置换术患者115例,根据手术麻醉方法的不同分为观察组60例和对照组55例,观察组予腰椎旁神经阻滞联合全凭静脉全身麻醉,对照组仅予全凭静脉全身麻醉。比较两组麻醉前(T0)、麻醉后10 min(T1)、麻醉后30 min(T2)、术毕(T3)时平均动脉压、心率、去甲肾上腺素及肾上腺素水平变化,术后清醒镇静效果和苏醒时间,以及两组手术期间不良反应发生情况。结果观察组T1、T2、T3时平均动脉压、心率与T0时比较虽略有升高,但差异无统计学意义(P>0.05);对照组T1、T2、T3时平均动脉压、心率与T0时比较均升高,且以T2时平均动脉压、心率最高,T3时又回落至T1时水平,差异有统计学意义(P<0.05)。T1、T2、T3时观察组平均动脉压、心率均低于对照组(P<0.05)。T1、T2、T3时两组去甲肾上腺素、肾上腺素均较T0时升高,且观察组相同时间点去甲肾上腺素、肾上腺素水平低于对照组,差异均有统计学意义(P<0.05或P<0.01)。观察组术后唤醒时警觉/镇静评分低于对照组,苏醒时间明显短于对照组,差异均有统计学意义(P<0.05)。两组手术期间总不良反应发生率比较差异无统计学意义(P>0.05)。结论腰椎旁神经阻滞联合全凭静脉全身麻醉用于髋关节置换术可有效防止患者血流动力学指标的波动,减轻手术应激反应程度,术后苏醒快,术后苏醒质量佳,且未增加手术期间不良反应的发生。Objective To observe the effect of lumbar paraspinal nerve block combined with total intravenous general anesthesia on hemodynamics,stress response and postoerative recovery after hip replacement.Methods From January 2018 to August 2019,115 patients undergoing hip replacement were selected and divided into observation group(n=60)and control group(n=55)according to different anesthesia methods.The observation group was treated with lumbar paraspinal nerve block combined with total intravenous general anesthesia,while the control group was only treated with total intravenous general anesthesia.The changes of mean arterial pressure(MAP),heart rate(HR),norepinephrine and epinephrine levels before anesthesia(T0),at 10 min after anesthesia(T1),30 min after anesthesia(T2),and at the end of operation(T3)were compared between the two groups.The recovery time and the effect of conscious sedation after operation,as well as the occurrence of adverse reactions during operation in the two groups were also compared.Results MAP and HR of the observation group at T1,T2 and T3 were slightly higher than those at T0,but the difference was not statistically significant(P>0.05).MAP and HR of the control group at T1,T2 and T3 were all higher than those at T0,and MAP and HR of the observation group at T2 were the highest and then declined to the levels of T1 at T3(P<0.05).MAP and HR at T1,T2 and T3 in the observation group were lower than those in the control group(P<0.05).At T1,T2 and T3,norepinephrine and epinephrine in the two groups were higher than those at T0,and the level of norepinephrine and epinephrine in the observation group was lower than that in the control group at the same time point(P<0.05 or P<0.01).The postoperative alertness/sedation score of the observation group was lower than that of the control group,and the recovery time was significantly shorter than that of the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Lumbar

关 键 词：腰椎旁神经阻滞 全凭静脉全身麻醉 关节成形术 置换 髋 血流动力学 应激反应 去甲肾上腺素 肾上腺素 苏醒时间 

分 类 号：R687.42[医药卫生—骨科学]