超声引导下神经阻滞复合喉罩全身麻醉在老年髋关节置换术中的应用效果  

Effect of Ultrasound-guided Nerve Block Combined with Laryngeal Mask General Anesthesia in Hip Replacement in the Elderly

作　　者：孟祥尚 刘辉 韩景田 MENG Xiangshang;LIU Hui;HAN Jingtian(Department of Anesthesia,Fukuang General Hospital,Liaoning Health Industry Group,Fushun 113008,China)

机构地区：[1]辽宁省健康产业集团抚矿总医院麻醉科,辽宁抚顺113008

出　　处：《中国医药指南》2021年第3期43-44,共2页Guide of China Medicine

摘　　要：目的探讨超声引导下神经阻滞复合喉罩全身麻醉在老年髋关节置换术中的应用效果。方法将2015年7月至2017年4月于我院接受髋关节置换术的114例老年患者随机分为两组,各57例,研究组采用超声引导下神经阻滞复合喉罩全身麻醉,对照组采用静吸复合全身麻醉气管插管。监测两组患者术中心率(HR)、平均动脉压(MAP)、心排血量(CO)、心脏指数(CI)、每搏输出量(SV)等血流动力学参数,计算最大变化率。记录术后视觉模拟量表(VAS)评分、术后首次下床活动时间及术后住院时间。观察术后近期并发症及预后效果。结果研究组术中HR、MAP、CO、CI、SV最大变化率明显低于对照组,差异有统计学意义(P<0.05)。研究组术后VAS评分低于对照组,术后首次下床活动时间短于对照组,差异有统计学意义(P<0.05),术中补液量、术后住院时间与对照组比较差异无统计学意义(P>0.05)。研究组术后谵妄、电解质紊乱等并发症发生率明显低于对照组,差异有统计学意义(P<0.05),而术后院内病死率及30 d内病死率与对照组比较差异无统计学意义(P>0.05)。结论老年髋关节置换术采用超声引导下神经阻滞复合喉罩全身麻醉,可更好的维持术中血流动力学平稳,并减轻术后疼痛,减少术后并发症的发生。Objective To investigate the effect of ultrasound-guided nerve block combined with laryngeal mask general anesthesia in hip replacement in the elderly.Methods From July 2015 to April 2017,114 cases of elderly patients with hip replacement were randomly divided into two groups,57 cases in each group.The research group received ultrasound-guided nerve block combined with laryngeal mask general anesthesia,and the control group received endotracheal intubation combined with static aspiration and general anesthesia.Hemodynamic parameters such as intraoperative central rate(HR),mean arterial pressure(MAP),cardiac output(CO),cardiac index(CI),and output per stroke(SV)were monitored to calculate the maximum rate of change.Postoperative pain score,time of first postoperative movement out of bed and time of postoperative hospitalization were recorded.To observe the postoperative complications and prognosis.Results The maximum change rates of HR,MAP,CO,CI and SV in the study group were significantly lower than those in the control group(P<0.05).The postoperative pain score and the first time to get out of bed after surgery were significantly shorter in the study group than in the control group,with statistical significance(P<0.05).There was no statistical significance in the comparison with the control group in the amount of intraoperative fluid supplementation and postoperative hospital stay(P>0.05).The incidence of postoperative delirium and electrolyte disorder in the study group was significantly lower than that in the control group,and the comparison was statistically significant(P<0.05),while there was no statistical significance in the postoperative death in the hospital and mortality within 30 d compared with the control group(P>0.05).Conclusion Ultrasound-guided nerve block combined with laryngeal mask general anesthesia can better maintain the stability of hemodynamics,reduce postoperative pain and reduce postoperative complications.

关 键 词：髋关节置换术 老年 超声引导下神经阻滞 喉罩全身麻醉 并发症 

分 类 号：R687.4[医药卫生—骨科学]