摘要
目的探讨超声引导下髂筋膜联合腰骶丛神经阻滞对老年髋关节置换手术患者应激反应及谵妄的影响。方法回顾性分析2017年1月至2019年12月青海省交通医院骨科行髋关节置换术治疗的97例老年髋关节疾病患者的临床资料,根据不同麻醉方式分为对照组(全身麻醉,62例)和观察组(超声引导下髂筋膜联合腰骶丛神经阻滞,35例)。记录并比较两组置入喉罩(T_(0))、切皮(T_(1))、置入假体(T_(2))、切口缝合(T_(3))时的血流动力学指标[平均动脉压(MAP)、心率、脉搏血氧饱和度(SpO_(2))];测定两组术前、术后24 h的应激反应指标(血清皮质醇、血糖);记录并比较两组术后6、12、24、48 h的谵妄发生率。结果各时点指标MAP、心率的主效应差异有统计学意义(P<0.05);不考虑测量时间,两组间MAP、心率的主效应差异有统计学意义(P<0.05);MAP、心率的时点间与组间存在交互作用(P<0.05),两组各时点的变化幅度不同;SpO_(2)的时点间与组间不存在交互作用(P>0.05)。术前、术后24 h血清皮质醇、血糖水平的主效应差异有统计学意义(P<0.01);不考虑测量时间,两组间血清皮质醇、血糖水平的主效应差异有统计学意义(P<0.01);血清皮质醇、血糖水平的时点间与组间存在交互作用(P<0.01),两组术前、术后24 h血清皮质醇、血糖水平的变化幅度不同。两组术后6、12、24、48 h的谵妄发生率比较差异无统计学意义(P>0.05)。结论超声引导下髂筋膜联合腰骶丛神经阻滞有助于稳定老年髋关节置换术患者血流动力学指标、减少应激反应、降低术后谵妄的发生率,对提高手术整体安全性有益。
Objective To investigate the effect of ultrasound-guided fascia iliaca combined with lumbosacral plexus nerve block anesthesia on stress response and delirium in elderly patients with hip replacement surgery.Methods The retrospective analysis was performed on the clinical data of 97 elderly patients with hip diseases who underwent hip replacement surgery in Department of Orthopedics,Qinghai Jiaotong Hospital from Jan.2017 to Dec.2019.According to different anesthesia methods,they were divided inT 0 a control group(general anesthesia,62 cases)and an observation group(ultrasound-guided iliac fascia combined with lumbosacral plexus block,35 cases).The hemodynamics[mean arterial pressure(MAP),heart rate,saturated pulse oxygen(SpO_(2))]of the two groups were recorded and compared at the time point of laryngeal mask implantation(T_(0)),skin incision(T_(1)),prosthesis implantation(T_(2)),and suture incision(T_(3));the stress response(serum cortisol,blood glucose)of the two groups was detected before surgery and 24 h after surgery;the incidences of delirium at 6,12,24,48 h after operation in the two groups were recorded.Results The differences of main effects of MAP and heart rate at each time point were statistically significant(P<0.05);regardless of the measurement time,there were statistical significant differences in the main effects of MAP and heart rate between the two groups(P<0.05);there were interactions in MAP and heart rate between groups and time points(P<0.05),the changing amplitudes of the two groups at different time points were different;there was no interaction between groups and time points of SpO_(2)(P>0.05).There were statistical significant differences in the main effects of serum cortisol and blood glucose levels before and 24 hours after operation(P<0.05);regardless of the measurement time,the differences of main effect of serum cortisol and blood glucose levels between the two groups were statistically significant(P<0.05);there were interactions in serum cortisol and blood glucose levels between g
作者
祁占花
张建业
范卫玲
QI Zhanhua;ZHANG Jianye;FAN Weiling(Department of Anesthesiology,Qinghai Jiaotong Hospital,Xining 810000,China)
出处
《医学综述》
CAS
2021年第7期1452-1456,共5页
Medical Recapitulate
关键词
髋关节置换术
髂筋膜联合腰骶丛神经阻滞
超声引导
应激反应
谵妄
Hip replacement
Iliaca combined with lumbosacral plexus nerve block
Ultrasound-guided
Stress response
Delirium
