超声引导下腰丛神经阻滞与连续收肌管阻滞在全髋关节置换术中的应用比较  

Comparison of ultrasound-guided lumbar plexus block and continuous adductor canal nerve block intotal hiparthroplasty

作　　者：王发兴 武旖旎 韩新[1] 代虹 李中华[1] 吴继敏[1] Wang Faxing;Wu Yini;Han Xin;Dai Hong;Li Zhonghua;Wu Jimin(Department of Anesthesia,Lishui People's Hospital,Lishui 323000,China)

机构地区：[1]丽水市人民医院麻醉科,丽水323000

出　　处：《中国医师进修杂志》2023年第9期785-790,共6页Chinese Journal of Postgraduates of Medicine

基　　金：浙江省医药卫生科技计划项目(2022ZH098、2021ZH061)。

摘　　要：目的:比较超声引导下腰丛神经阻滞(LPB)与连续收肌管阻滞(ACNB)在全髋关节置换术(THA)中的应用价值,探讨THA的麻醉方案。方法:采用前瞻性研究,收集2019年3月至2022年2月丽水市人民医院接受THA的90例患者作为研究对象,按照随机数字表法将患者分为试验组和对照组各45例,对照组接受LPB+全身麻醉,试验组接受ACNB+全身麻醉。评价两组血流动力学参数[入室时(T_(1))、切骨时(T_(2))、假体植入时(T_(3))、术毕即刻(T_(4))的心率(HR)、平均动脉压(MAP)],疼痛程度[苏醒后6 h(S_(1))、12 h(S_(2))、24 h(S_(3))、48 h(S_(4))的视觉模拟评分(VAS)],麻醉药物使用剂量,比较LPB、ACNB在THA中的麻醉效果。 结果:从T_(2)时点开始,两组患者HR有升高趋势[T_(2):(85.24 ± 4.26)次/min比(86.13 ± 4.86)次/min;T_(3):(83.82 ± 5.11)次/min比(85.16 ± 3.56)次/min;T_(4):(81.64 ± 4.32)次/min比(82.24 ± 4.62)次/min],MAP处于降低趋势[T_(2):(86.54 ± 4.25)mmHg(1 mmHg = 0.133 kPa)比(85.35 ± 4.66)mmHg;T_(3):(86.15 ± 3.92)mmHg比(84.86 ± 4.13)mmHg;T_(4):(90.65 ± 5.25)mmHg比(92.12 ± 4.62)mmHg],不同时点之间比较差异有统计学意义( P<0.05);两组不同时间HR、MAP及变化趋势比较差异无统计学意义( P>0.05)。两组VAS从S_(2)时点开始处于升高趋势,不同时点之间比较差异有统计学意义( P<0.05);试验组VAS升高趋势小于对照组,且不同时点VAS均低于对照组( P<0.05)。试验组舒芬太尼使用剂量少于对照组[(114.37 ± 16.61)μg比(131.36 ± 18.31)μg],镇痛泵按压次数少于对照组[6.00(5.00,6.50)次比8.00(7.00,9.00)次],差异有统计学意义( P<0.05)。 结论:超声引导下LPB和ACNB用于THA中均能够维持血流动力学稳定,尤其ACNB在THA后48 h内能够发挥镇痛优势,减少镇痛药物使用剂量。Objective To compare the application value of ultrasound-guided lumbar plexus block(LPB)and continuous adductor canal nerve block(ACNB)in total hip arthroplasty(THA),and to explore the anesthesia scheme of THA.Methods A prospective randomized controlled trial was used.Ninety patients who received THA admitted to in Lishui People's Hospital from March 2019 to February 2022 were selected as the study subjects.According to the random number table method,90 patients were divided into the test group and the control group,with 45 patients in each.The control group received LPB+general anesthesia,and the test group received ACNB+general anesthesia.By evaluating the hemodynamic parameters heart rate(HR)and mean arterial pressure(MAP)at the time of entry(T),osteotomy(T2),prosthesis implantation(T3)and immediately after surgery(Ta);the pain degree visual analogue score(VAS)at 6 h(Si),12 h(S2),24 h(Ss),48 h(S4)after awakening;the dosage of anesthetic drugs,the anesthetic effects of LPB and ACNB in THA were compared.Results From T²to T,HR of patients in the two groups had a trend of increase:(85.24±4.26)times/min vs.(86.13±4.86)times/min,(83.82±5.11)times/min vs.(85.16±3.56)times/min and(81.64±4.32)times/min vs.(82.24±4.62)times/min,while MAP was in a downward trend:(86.54±4.25)mmHg(1 mmHg=0.133 kPa)vs.(85.35±4.66)mmHg,(86.15±3.92)mmHg vs.(84.86±4.13)mmHg and(90.65±5.25)mmHg vs.(92.12±4.62)mmHg.The difference at different time points was statistically significant(P<0.05).There was no statistically significant difference in HR,MAP and change trend between the two groups at different time(P>0.05).The VAS score of the two groups increased from S2 time point,and the difference between different time points was statistically significant(P<0.05).The rising trend of VAS score in the test group was lower than that in the control group,and the VAS score at different time points was lower than that in the control group(P<0.05).The dosage of sufentanil used in the test group was less than that in the control group:(114.37�

关 键 词：髋关节 超声心动描记术 超声心电图 置换术 腰丛神经阻滞 收肌管神经阻滞 

分 类 号：R614[医药卫生—麻醉学]