摘要
目的探讨人工全髋关节置换术(THA)采用腰丛神经阻滞联合全身麻醉及采取控制性降压的临床效果。方法本研究采用前瞻性随机临床试验,选取2018年4月至2021年12月吕梁市人民医院收治的80例拟接受THA手术的患者作为临床研究对象,按照随机数字表将其分为研究组和对照组,各40例。两组患者均采用腰丛神经阻滞联合全身麻醉作为术中麻醉方法,研究组同时采取控制性降压措施。观察两组患者的喉罩置入时(T0)、手术切皮时(T1)、假体植入时(T2)、术毕时(T3)时刻的血流动力学指标以及围手术期指标、血红蛋白、红细胞压积(HCT)、血小板计数(PLT)、麻醉药物使用情况、不良反应发生率差异。结果两组患者在T0~T3时刻的平均动脉压(MAP)、心率、血氧饱和度(SpO_(2))指标的动态波动变化趋势差异无统计学意义(P>0.05);两组患者的SpO_(2)测定值在T1~T3时刻较本组T0时刻均有上升趋势,差异有统计学意义(P<0.05)。研究组患者的总失血量、显性失血量、隐性失血量、输血量为(613.8±77.4)、(144.8±41.3)、(469.0±64.5)、(355.6±80.6)mL,均显著低于对照组[(942.0±85.0)、(178.9±43.0)、(763.1±75.6)、(559.2±94.5)mL],差异均有统计学意义(P<0.05)。两组患者的舒芬太尼、佩尔地平、麻黄碱、术后24 hPCA用量情况比较,差异均无统计学意义(P>0.05)。研究组患者术后第1天、第3天的血红蛋白测定值为(129.03±5.96)、(132.70±5.00)g/L,高于对照组[(126.17±4.80)、(128.94±5.73)g/L],在术后第1天的HCT测定值为(36.80±4.83)%,高于对照组[(34.60±3.92)%],差异均有统计学意义(P<0.05)。研究组手术并发症发生率为10.00%,显著低于对照组(30.00%),差异有统计学意义(P<0.05)。结论腰丛神经阻滞联合全身麻醉THA手术患者同时采取控制性降压措施能显著减少手术出血量,减少手术并发症的发生。
Objective To explore the clinical effect of lumbar plexus block combined with general anesthesia and controlled hypotension in total hip replacement(THA).Methods In this study,a randomized clinical trial was conducted.Eighty patients who planned to undergo tha surgery in Lyuliang People's Hospital from April 2018 to December 2021 were selected as the clinical research objects.They were divided into the study group and the control group with a random number table.Patients in both groups used lumbar plexus block combined with general anesthesia as the intraoperative anesthesia method.The hemodynamic indexes at LMA insertion(T0),surgical incision(T1),prosthesis implantation(T2),and operation completion(T3),perioperative indicators,hemoglobin and hematocrit(HCT),platelet(PLT),anesthetic use,and the incidence of adverse reactions were observed in the two groups.Results There was no significant difference in the dynamic fluctuation trend of mean arterial pressure(MAP),heart rate and blood oxygen saturation(SpO_(2))between the two groups at T0-T3(P>0.05);the measured value of SpO_(2) in the group of patients at T1-T3 time was higher than that at the time of T0 in this group,the differences was statistically significant(P<0.05).The total blood loss,dominant blood loss,hidden blood loss and blood transfusion volume of the patients in the study group were(613.8±77.4),(144.8±41.3),(469.0±64.5),(355.6±80.6)mL,which were significantly lower than those in the control group[(942.0±85.0),(178.9±43.0),(763.1±75.6),(559.2±94.5)mL],the differences were statistically significant(P<0.05).There was no significant difference in the dosage of sufentanil,perdipine,ephedrine,and 24 h PCA between the two groups(P>0.05).The hemoglobin measurement values of patients in the study group on the first and third days after operation were(129.03±5.96),(132.70±5.00)g/L,which were higher than those in the control group[(126.17±4.80),(128.94±5.73)g/L],and the HCT measurement values on the first day after operation was(36.80±4.83)%,which
作者
刘浩宇
严小纯
刘健
LIU Hao-yu;YAN Xiao-chun;LIU Jian(Department of Anesthesiology,Lyuliang People's Hospital,Lyuliang Shanxi 033000,China)
出处
《临床和实验医学杂志》
2022年第23期2571-2575,共5页
Journal of Clinical and Experimental Medicine
基金
山西省卫生计生委科研项目(编号:20180406135)。
