摘要
目的对比全麻和腰从-坐骨神经阻滞应用于老年髋关节置换术中的麻醉效果以及对患者血流动力学、术后认知功能的影响。方法选择2017年6月至2020年6月于嘉兴市第一医院接受镜关节置换的老年患者114例。根据不同麻醉方式分为采用全麻的对照组和采用腰丛坐骨神经阻滞的观察组,每组各57例。记录患者苏醒、定向力恢复、拨管时间以及感觉阻滞、恢复痛觉、麻醉起效时间。观察患者在麻醉前、麻醉后15 min、术后15 min的心率(HR)、平均动脉压(MAP)变化。比较患者术前、术后6.24.72 h的简易智能检查状态评分(MMSE)变化。记录患者术后不良反应发生情况。结果观察组苏醒时间、定向力恢复时间、拔管时间均少于对照组(P<0.05):观察组麻醉起效时间、感觉阻滞时间、恢复痛觉时间均少于对照组(P<0.05)。对照组麻醉后15 min、术后15 min HR,MAP均低于麻醉前(P<0.05),观察组麻醉后15 min HR,MAP均低于麻醉前(P<0.05),且观察组麻醉后15 min,术后15 min HR,MAP均高于对照组(P<0.05)。对照组术后6.24 h MMSE评分均低于术前(P<0.05),观察组术后6h MMSE评分低于术前(P<0.05),且观察组术后6.24 h MMSE评分均高于对照组(P<0.05)。观察组不良反应总发生率(8.77%)低于对照组(22.81%)(P<0.05),结论相较丁全麻,腰丛-坐骨神经阻滞麻醉效果更佳,患者术中血流动力学更稳定,并且对术后认知功能影响更小,安全性好。
Objective To compare the application of general anesthesia and lurnbar plexus-sciatio nerve block in elderly hip replacement surgery and the effeets on the anesthesia effeet,hemodvnamies,and postoperative cognitive function of patients.Methods A total of 114 elderly patients who received hip replacement in the First hospital of Jiaxing from June 2017 to June 2020 were selected.According to different anesthesia methods,they were divided into control group with general anesthesia and observation group with lumbar plexus sciatic nerve block,57 cases in each group.The recovery time of recovery of orientation,extubation time,sensory block,recovery of pain and onset time of anesthesia were recorded.The changes of heart rate(HR)and mean arterial pressure(MAP)were observed before anesthesia.15 minutes after anesthesia and 15 minutes after operation.The changes of mini-mental state examination(MMSE)seore before operation,6 h,24 h and 72 h after operation were compared.The incidence of adverse reactions was reconded.Results The recovery time,orientation recovery time and extubation time in the observation group were less than those in the control group(P<0.05);the anesthesia onse time,sensory block time and pain recovery time in the observation group were less than those in the contro group(Pc0.05).The HR and MAP of the control group at 15 min aftcr ancathesia and 15 min efteroperation were lower than those before anesthesia(P<0.05),while the HR and MAP 15 min after anesthesia in observation group were lower than those before anesthesia(P<0.05);the HR and MAP of the observation group at 15 min after anesthesia and 15 min after operation were higher than those of the control group(P<0.05).The MMSE scores at 6 h and 24 h in the control group were lower than those before the operation(P<0.05),and the MMSE scores at 6 h in the observation group were lower than those before the operation(P<0.05);the MMSE scores at 6 h and 24 h in the obsenation group were higher than those in the control group(P<0.05).The total incidence of adverse reactions in the observation group(8.77%)was lower than that in the control group(22.81%)(P<0.05).Conclusions Compared with general anesthesia,lumbar plexus sciatic nerve block anesthesia effect is better,with stable hemotlynamics,smaller impact on postoperative cognitive function and good safety.
作者
许世杰
于佳
刘明娟
Xu Shijie;Yu Jia;Liu Mingjuan(Department of Anesthesiology,the First Hospital of Jiating,Jiaxing 314000,China;Department of Anes-thesiologr.Tongxiang Maternal and Child Health Haspital,Tongxiang 314500,China)
出处
《中国医师杂志》
CAS
2020年第12期1769-1773,共5页
Journal of Chinese Physician
基金
浙江省医药卫生科技计划项目(2020KY949)。
