超声联合神经刺激器引导下腰丛神经阻滞在老年全髋关节置换术中的应用效果  

Effect of lumbar plexus nerve block guided by ultrasound combined with nerve stimulator on elderly patients undergoing total hip replacement

作　　者：许金梅 Xu Jinmei(Department of Anesthesiology,the First People’s Hospital of Zhumadian,Zhumadian 463000,China)

机构地区：[1]河南省驻马店市第一人民医院麻醉科,463000

出　　处：《中国实用医刊》2021年第6期64-67,共4页Chinese Journal of Practical Medicine

摘　　要：目的探讨超声联合神经刺激器引导下腰丛神经阻滞在老年全髋关节置换术中的应用效果。方法采用随机数字表法将2019年1月至2020年1月在驻马店市第一人民医院接受全髋关节置换术治疗的老年患者96例分为两组,两组均实施腰丛神经阻滞,观察组(48例)通过超声联合神经刺激器引导,对照组(48例)通过超声引导,比较两组穿刺、阻滞情况,记录并比较两组入室后5 min(T1)、切皮时(T2)、术毕(T3)、术后30 min(T4)血流动力学如平均动脉压(MAP)、心率(HR),记录并比较两组术前、术后24 h脑神经功能损伤指标如中枢神经特异性蛋白(S100β)、神经原特异性烯醇化酶(NSE)。结果两组穿刺次数、穿刺时间比较,差异未见统计学意义(P>0.05);观察组感觉和运动阻滞起效时间均短于对照组(P<0.05);与T1时点比较,对照组T2、T3时点MAP、HR升高,并于T4时点回降,与T1时点比较,观察组T2的MAP、HR降低,在T3时点回升,T4时点较T3时点无明显变化,且T2~T4的MAP、HR均低于对照组(P<0.05);术后24 h,两组S100β、NSE均较术前升高,但观察组低于对照组(P<0.05)。结论老年全髋关节置换术中应用超声联合神经刺激器引导下腰丛神经阻滞,可以缩短感觉和运动阻滞起效时间,更有利于稳定围手术期血流动力学,且不会对脑神经产生较大影响,利于对脑神经的保护。Objective To investigate the effect of lumbar plexus nerve block guided by ultrasound combined with nerve stimulator on elderly patients undergoing total hip replacement.Methods A total of 96 elderly patients who underwent total hip replacement in the First People’s Hospital of Zhumadian from January 2019 to January 2020 were divided into two groups according to the random number table method.Lumbar plexus block was performed in both groups,the observation group(48 cases)was guided by ultrasound combined with neurostimulator,and the control group(48 cases)was guided by ultrasound.The puncture and block conditions of the two groups was compared,the hemodynamics such as mean arterial pressure(MAP),heart rate(HR)were recorded and compared between the two groups at 5 min after entry(T1),skin incision(T2),after surgery(T3),30 min after surgery(T4),the injury indexes of the cerebral nerve function such as central nerve specific protein(S100β),neuron specific enolase(NSE)were recorded and compared between the two groups before operation and 24 hours after operation.Results There was no significant difference in puncture times and puncture time between the two groups(P>0.05);the onset time of sensory and motor block in the observation group was shorter than that in the control group(P<0.05);compared with T1,the MAP and HR of the control group were increased at T2 and T3,and were decreased at T4.Compared with T1,the MAP and HR of the observation group at T2 were decreased,and were increased at T3.There was no significant change at T4 compared with T3,and the MAP and HR at T2-T4 were lower than those of the control group(P<0.05);24 h after operation,the S100βand NSE of the two groups were higher than those before operation,but those in the observation group was lower than those in the control group(P<0.05).Conclusions The use of ultrasound combined with nerve stimulatorto guide lower lumbar plexus block in elderly total hip replacement can shorten the onset time of sensory and motor block.It is more conducive to stabil

关 键 词：全髋关节置换术 超声 腰丛神经阻滞 老年 神经刺激器 

分 类 号：R614[医药卫生—麻醉学]