目的:探讨超声引导下髂筋膜间隙阻滞联合腰硬联合麻醉对老年髋关节手术患者的影响。方法:选取 2021 年1 月—2023 年 4 月于南京市浦口区中医院接受髋关节手术的 102 例老年患者作为研究对象，患者接受髋关节置换或复位内固定术治疗，根据随机数表法将患者分为对照组和观察组，各 51 例。对照组行腰硬联合麻醉，观察组在腰硬联合麻醉基础上行超声引导下髂筋膜间隙阻滞麻醉。对比两组平均动脉压、心率、术后镇痛用药情况[术后舒芬太尼用量、经静脉患者自控镇痛(PCIA)开始按压时间及按压次数]、应激反应指标[超氧化物歧化酶(SOD)、晚期氧化蛋白产物(AOPP)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)]、视觉模拟评分法(VAS)评分、简易智力状态检查量表(MMSE)、中枢神经特异蛋白(S100-β)、β-淀粉样蛋白 1～40(Aβ1～40)水平、不良反应及满意度。结果:两组麻醉前、手术开始时及手术结束时平均动脉压和心率比较，差异无统计学意义(P>0。05);观察组蛛网膜下腔阻滞体位摆放时平均动脉压和心率低于对照组，差异有统计学意义(P<0。05)。观察组术后舒芬太尼用量少于对照组，PCIA开始按压时间晚于对照组，PCIA按压次数少于对照组，差异有统计学意义(P<0。05)。观察组术后 5 d SOD、GSH-Px水平高于对照组，AOPP、MDA水平低于对照组，差异有统计学意义(P<0。05)。观察组术后 12 h、1 d、3 d VAS评分低于对照组，差异有统计学意义(P<0。05)。观察组术后 6 h、1 d、2 d MMSE评分高于对照组，差异有统计学意义(P<0。05)。观察组术后 6 h、1 d S100-β、Aβ1～40 水平均低于对照组，差异有统计学意义(P<0。05)。观察组不良反应发生率低于对照组，总满意度高于对照组，差异有统计学意义(P<0。05)。结论:老年髋关节手术患者接受超声引导下髂筋膜间隙阻滞联合腰硬联合麻醉方法，可改善麻醉操作期间平均动脉压和心率指标水平，减少术后镇痛药物使用剂量，减轻机体应激反应，降低术后疼痛感，改善术后认知功能，降低并发症发生率，提高满意率。
Effect of Ultrasound-guided Iliofascial Space Block Combined with Combined Lumbar and Epidural Anesthesia in Elderly Patients Undergoing Hip Joint Surgery
To investigate the effect of ultrasound-guided iliofascial space block combined with combined lumbar and epidural anesthesia in elderly patients undergoing hip joint operation.Method:A total of 102 patients who received hip joint operation in Nanjing City Pukou District Traditional Chinese Medicine Hospital from January 2021 to April 2023 were selected as the study objects,patients received hip replacement or reduction internal fixation.According to random number table method,the patients were divided into control group and observation group,with 51 cases in each group.The control group was given combined lumbar and epidural anesthesia,and the observation group was given ultrasound-guided iliofascial space block on the basis of combined lumbar and epidural anesthesia.The mean arterial pressure,heart rate,postoperative analgesic medication[postoperative Sufentanil dosage,intravenous patient-controlled analgesia(PCIA)start pressing time and pressing times],stress response indicators[superoxide dismutase(SOD),advanced oxidation protein products(AOPP),glutathione peroxidase(GSH-Px),malondialdehyde(MDA)],visual analogue scale(VAS)score,mini-mental state examination(MMSE),central nervous system specific protein(S100-β),β-amyloid protein 1-40(Aβ1-40)levels,adverse reactions and satisfaction were compared between two groups.Result:There were no significant differences in mean arterial pressure and heart rate between two groups before anesthesia,at the beginning of operation and at the end of operation(P>0.05);the mean arterial pressure and heart rate in the observation group at the subarachnoid block position were lower than those in the control group,and the differences were statistically significant(P<0.05).The postoperative Sufentanil dosage in the observation group was less than that in the control group,the time of PCIA start pressing was later than that in the control group,and the PCIA pressing times was less than that in the control group,the differences were statistically significant(P<0.05).The levels of SOD and GSH-Px in the observation group at 5 d after operation were higher than those in the control group,and the levels of AOPP and MDA were lower than those in the control group,the differences were statistically significant(P<0.05).The VAS scores of the observation group at 12 h,1 d and 3 d after operation were lower than those of the control group,and the differences were statistically significant(P<0.05).The MMSE scores of the observation group at 6 h,1 d and 2 d after operation were higher than those of the control group,and the differences were statistically significant(P<0.05).The levels of S100-β and Aβ1-40 in the observation group at 6 h and 1 d after operation were lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group,and the total satisfaction was higher than that in the control group,the differences were statistically significant(P<0.05).Conclusion:The use of ultrasound-guided iliofascial space block combined with lumbar epidural anesthesia in undergoing hip joint operation can improve the mean arterial pressure and heart rate indexes during anesthesia,reduce the dosage of postoperative analgesics,alleviate the body's stress response,reduce postoperative pain,improve postoperative cognitive function,reduce the incidence of complications,and increase the satisfaction rate.
Ultrasound-guided iliofascial space blockLumbar and epidural anesthesiaHip replacementReduction and internal fixationAnalgesic effectSatisfaction degree
万方数据
维普
