超声引导下腰椎椎旁神经阻滞联合浅全身麻醉在高龄患者髋关节置换术中的应用效果  

Application effect of ultrasound-guided lumbar paraspinal nerve block combined with shallow general anesthesia during hip arthroplasty in elderly patients

作　　者：郭刚 倪婧婧 汪永刚 郭玮 丁少成 华东 GUO Gang;NI Jing-jing;WANG Yong-gang;GUO Wei;DING Shao-cheng;HUA Dong(Department of Anesthesiology,Maanshan Central Hospital,Maanshan 243000,China;Department of Orthopaedics Ward 2,Affiliated Hospital of West Anhui Health Vocational College,Lu′an 237005,China)

机构地区：[1]安徽省马鞍山市中心医院麻醉科,马鞍山市243000 [2]皖西卫生职业学院附属医院骨科二病区,安徽省六安市237005

出　　处：《广西医学》2021年第11期1301-1304,共4页Guangxi Medical Journal

基　　金：安徽省高校自然科学研究(KJ2019A1258)。

摘　　要：目的探讨超声引导下腰椎椎旁神经阻滞联合浅全身麻醉在高龄患者髋关节置换术中的应用效果。方法将行髋关节置换术治疗的80例高龄股骨颈骨折患者分为观察组与对照组,各40例。观察组患者采用超声引导下腰椎椎旁神经阻滞联合浅全身麻醉,对照组患者采用常规全身麻醉。比较两组患者术中舒芬太尼、丙泊酚及顺阿曲库铵用量、手术结束时两组患者血清神经肽Y和P物质水平,以及术后24 h内疼痛数字评价量表(NRS)评分、围麻醉期血清超敏C反应蛋白(hs-CRP)水平;观察两组患者麻醉苏醒情况及麻醉并发症发生情况。结果观察组术中舒芬太尼、丙泊酚及顺阿曲库铵的用量均少于对照组(均P<0.05)。手术结束时,观察组的血清神经肽Y和P物质水平均低于对照组;术后6 h、12 h及24 h,观察组疼痛NRS评分均低于对照组,且观察组术后6 h、术后24 h的血清hs-CRP水平均低于对照组(均P<0.05)。观察组呼之睁眼时间、拔除气管导管时间及复苏室停留时间均短于对照组,且术中高血压、术中低血压、术后苏醒延迟及术后认知功能障碍的发生率均低于对照组(均P<0.05)。结论高龄髋关节置换术患者采用超声引导下腰椎椎旁神经阻滞联合浅全身麻醉,能减少术中舒芬太尼、丙泊酚及顺阿曲库铵的用量,以及麻醉并发症的发生和机体致痛物质、炎症因子的释放,有效缓解患者术后疼痛,促进患者麻醉恢复。Objective To investigate the application effect of ultrasound-guided lumbar paraspinal nerve block combined with shallow general anesthesia during hip arthroplasty in elderly patients.Methods Eighty elderly patients with femoral neck fracture treated with hip arthroplasty were divided into observation group(n=40)and control group(n=40).Patients in the observation group were treated with ultrasound-guided lumbar paraspinal nerve block combined with shallow general anesthesia,while patients in the control group were treated with routine general anesthesia.The related indices were compared between the two groups,including intraoperative dosages of sufentanil,propofol and cisatracurium,serum levels of neuropeptide Y and substance P at the end of operation,as well as the Numerical Rating Scale(NRS)pain score within 24 hours after operation and serum level of perianesthesic high-sensitivity C-reactive protein(hs-CRP);the recovery from anesthesia and the incidence of anesthetic complications of the patients were observed in the two groups.Results The observation group exhibited decreased dosages of intraoperative sufentanil,propofol and cisatracurium than the control group(all P<0.05).At the end of operation,serum neuropeptide Y and substance P levels in the observation group were lower than those in the control group;six,12 and 24 hours after operation,the observation group exhibited lower NRS pain scores than the control group,moreover,six and 24 hours after operation,serum hs-CRP level was lower in the observation group than in the control group(all P<0.05).Compared with the control group,the observation group had shorter eye opening time,tracheal catheter extubation time and resuscitation room stay,and lower incidence rates of intraoperative hypertension,intraoperative hypotension,postoperative delayed recovery and postoperative cognitive impairment(all P<0.05).Conclusion For elderly patients undergoing hip arthroplasty,ultrasound-guided lumbar paraspinal nerve block combined with shallow general anesthesia can decr

关 键 词：髋关节置换术 腰椎 椎旁神经阻滞 超声引导 浅全身麻醉 高龄 并发症 

分 类 号：R683.421[医药卫生—骨科学]