摘要
目的:探讨神经刺激仪引导定位坐骨神经-股神经阻滞对老年全髋置换术患者术后认知功能障碍、血流动力学等的影响,为老年全髋置换术患者制定合理麻醉方案提供参考。方法:以2015年1月～2017年1月西安高新医院收治的86例老年全髋置换术患者为对象,依据麻醉方案不同分为对照组(实施硬膜外麻醉, n=45)和观察组(实施神经刺激仪引导定位坐骨神经-股神经阻滞麻醉, n=41)。观察两组不同时间点[入室后(T0)、手术即刻(T1)、手术开始后30 min(T2)、手术结束后(T3)]的血流动力学指标[平均动脉压(MAP)、心率]变化,比较两组麻醉效果(镇痛维持时间、达到最高阻滞平面时间)、认知功能障碍[简易智能量表(MMSE)评估]、不良反应发生情况。结果:T0时,两组的MAP、心率和术前MMSE评分相比较无明显差异(P>0.05)。与T0相较,T1、T2、T3时,两组MAP均明显降低;T1、T2时,仅对照组心率明显降低(P<0.05)。对照组各时点MAP、心率变化幅度较观察组明显大(P<0.05)。与对照组相比较,观察组的镇痛维持时间明显长,达最高阻滞平面时间明显短(P<0.05);术后1、7 d,观察组MMSE评分均较对照组明显高(P<0.05);观察组不良反应总发生率为21.95%,明显低于对照组的44.44%(P<0.05)。结论:神经刺激仪引导定位坐骨神经-股神经阻滞对老年全髋置换术患者的麻醉效果佳,有效减轻患者术后认知功能障碍,对血流动力学干扰少且安全性好。
Objective To investigate the effects of nerve stimulator-guided sciatic nerve-femoral nerve block on cognitive impairment and hemodynamics in elderly patients after total hip arthroplasty for providing some references for the development of a reasonable anesthesia regimen for elderly patients receiving total hip arthroplasty.Methods A total of 86 elderly patients undergoing total hip arthroplasty in Xi'an Gaoxin Hospital from January 2015 to January 2017 were selected as the subjects.According to different anesthesia regimens,the patients were divided into control group(given epidural anesthesia,n=45)and observation group(given nerve stimulator-guided sciatic nerve-femoral nerve block anesthesia,n=41).The changes of hemodynamic indexes,including mean arterial pressure(MAP)and heart rate,in the two groups at different time points[entering the operating room(T0),the beginning of operation(T1),30 minutes after the beginning of operation(T2),the end of operation(T3)]were analyzed.The anesthetic effects(duration of analgesia,time to the highest block level),cognitive impairment[minimental state examination(MMSE)]and adverse reactions were compared between two groups.Results No significant differences were found in MAP,heart rate and preoperative MMSE score between two groups at T0(P>0.05).The MAP of both two groups was significantly decreased at T1,T2 and T3 as compared with T0.At T1 and T2,only the heart rate of control group was decreased significantly(P<0.05).The changes of MAP and heart rate in control group at different time points were significantly greater than those in observation group(P<0.05).The duration of analgesia was significantly longer and the time to the highest block level was shorter in observation group as compared with control group(P<0.05).The MMSE scores in observation group at 1 day and 7 days after finishing operation were significantly higher than those in control group(P<0.05).The total incidence of adverse reactions in observation group was 21.95%,significantly lower than 44.44%in control
作者
肖水亮
周红社
XIAO Shuiliang;ZHOU Hongshe(Department of Anesthesiology,Xi'an Gaoxin Hospital,Xi'an 710075,China)
出处
《中国医学物理学杂志》
CSCD
2018年第9期1094-1098,共5页
Chinese Journal of Medical Physics
