腰部竖脊肌平面阻滞对老年人髋关节置换术后谵妄和早期转归的影响  

Effects of lumber luerector spinae plane block on postoperative delirium and early outcome in older adult patients undergoing hip arthroplasty

作　　者：孔宪刚[1] 宋成军[1] 王昆[1] 尤培军[1] Kong Xiangang;Song Chengjun;Wang Kun;You Peijun(Department of Anesthesiology,Jining No.1 People's Hospital,Jining 272011,Shandong Province,China)

机构地区：[1]济宁市第一人民医院麻醉科,济宁272011

出　　处：《中国基层医药》2022年第9期1281-1286,共6页Chinese Journal of Primary Medicine and Pharmacy

基　　金：山东省济宁市重点研发计划项目(2020YXNS032)。

摘　　要：目的评估超声引导下腰部竖脊肌平面阻滞(L-ESPB)联合喉罩全身麻醉对老年患者髋关节置换术后谵妄(POD)和早期转归的影响。方法选取济宁市第一人民医院2020年8月至2021年5月择期喉罩全身麻醉下行单侧髋关节置换术老年患者60例,采用随机数字表法分为观察组和对照组各30例。两组均行喉罩全身麻醉,观察组全身麻醉诱导前行L-ESPB,注射0.375%罗哌卡因30 mL。术毕行患者自控静脉镇痛(PCIA),疼痛视觉模拟评分(VAS)>4分,静脉注射地佐辛行补救镇痛。记录术中全身麻醉药用量及血管活性药物使用率,拔喉罩时间,麻醉恢复室(PACU)停留时间及苏醒期躁动发生率,术后4、8、12、24、48 h静息VAS评分和患者舒适度评分(BCS),术后48 h内镇痛泵有效按压次数、镇痛补救率、镇痛相关不良反应发生率,术前1 d、术后1 d、3 d、5 d匹兹堡睡眠质量指数(PSQI)评分及术后5 d内POD发生率,术后首次下床活动时间及肺部并发症发生率。结果与对照组相比,观察组术中瑞芬太尼、丙泊酚用量明显减少(t=-6.80、-5.23,均P<0.05),乌拉地尔、艾司洛尔使用率明显降低(χ^(2)=4.32、5.46,均P<0.05)。观察组术后拔喉罩时间、PACU停留时间、术后首次下床时间分别为(14±2)min、(21±2)min、(2.4±0.5)d,均明显短于对照组的(18±2)min、(26±3)min、(2.8±0.7)d(t=-6.64、-7.18、-2.51,均P<0.05)。观察组苏醒期躁动、POD、肺部感染发生率分别为0.0%、3.3%、0.0%,均明显低于对照组的20.0%、26.7%、20.0%(均P<0.05)。与对照组比较,观察组术后各时点静息VAS评分明显降低(t=3.32、2.97、4.33、3.81、3.10,均P<0.05),BCS评分均明显升高(t=9.20、8.62、5.73、5.72、6.28,均P<0.05)。观察组术后48 h内镇痛泵有效按压次数、镇痛补救率、恶心呕吐发生率分别为0(0,0)、10.0%、6.7%,均明显低于对照组的1(0,2)、33.3%、30.0%(Z=-3.41,χ^(2)=4.81、5.46,均P<0.05)。与术前1 d比较,术后1、3、5 d两组Objective To investigate the effects of ultrasound-guided lumbar erector spinae plane block(L-ESPB)combined with general anesthesia using a laryngeal mask airway on postoperative delirium and early outcome in older adult patients undergoing hip arthroplasty.Methods Sixty older adult patients who underwent unilateral total hip arthroplasty under general anesthesia using a laryngeal mask airway from August 2020 to May 2021 were included in this study.They were randomly assigned to observation and control groups,with 30 patients in each group.All patients underwent general anesthesia using a laryngeal mask airway.In the observation group,L-ESPB with 30 mL 0.375%ropivacaine was performed before induction of general anesthesia.Patient-controlled intravenous analgesia was performed in all patients after surgery.The Visual Analogue Scale score was>4 points,and dezocine was intravenously injected for rescue analgesia.The amount of general anesthetics,the rate of use of vasoactive drugs,the time to pull out the laryngeal mask airway,length of stay in postanesthesia care unit,and the incidence of restlessness during the recovery period were recorded.Resting-state VAS score and Bruggrmann comfort scale score at 4,8,12,24 and 48 hours after surgery,effective times of pressing the analgesia pump,the rate of rescue analgesia,the incidence of anesthesia-related adverse reactions at 48 hours after surgery,Pittsburgh Sleep Quality Index(PSQI)score at 1 day before and 1,3 and 5 days after surgery,the incidence of postoperative delirium within 5 days after surgery,the time to get out of bed the first time,and the incidence of pulmonary infection were recorded.Results The amount of remifentanil and propofol used during surgery were significantly lower in the observation group than those in the control group(t=-6.80,-5.23,both P<0.05).The rate of use of urapidil and esmolol were significantly lower in the observation group than those in the control group(χ^(2)=4.32,5.46,both P<0.05).The time to pull out the laryngeal mask airway,len

关 键 词：神经传导阻滞 超声检查 关节成形术 置换 髋 谵妄 康复 老年人 

分 类 号：R614[医药卫生—麻醉学]