摘要
目的探讨超声引导下不同入路髂筋膜间隙阻滞在全髋关节置换术中的麻醉效果及对术后认知功能和炎症反应的影响。方法前瞻性选取2020年3月至2021年3月安庆市立医院收治的60例全髋关节置换患者作为研究对象,按照随机数字表法将患者分为观察组与对照组,每组30例。所有患者在局部麻醉后,均采取超声引导下髂筋膜间隙阻滞,对照组采取平行穿刺入路,观察组采取垂直穿刺入路。比较两组患者的麻醉效果,麻醉药用量与术中指标,基础值(T_(1))、麻醉诱导后(T_(2))、切皮时(T_(3))、手术结束即刻(T_(4))的生命体征[血氧饱和度(SpO_(2))、收缩压、舒张压、平均动脉压(MAP)、心率],手术后3 d的炎症因子[白细胞计数(WBC)、降钙素原、C反应蛋白(CRP)]变化情况,并对比手术后1、3、5 d患者的S100B蛋白与褪黑素水平。结果观察组麻醉优良率为100.00%,明显高于对照组(83.33%),差异有统计学意义(P<0.05)。观察组穿刺次数和穿刺注药时间均明显高于对照组,观察组术中丙泊酚用量、术中瑞芬太尼用量均较对照组低,差异均有统计学意义(P<0.05)。T_(1)~T_(4)时间点,对照组SpO_(2)、心率、MAP、舒张压、收缩压比较,差异均有统计学意义(P<0.05),而观察组SpO_(2)、心率、MAP、舒张压、收缩压比较,差异均无统计学意义(P>0.05);T_(2)和T_(3)时间点,观察组患者SpO_(2)、心率、MAP、舒张压、收缩压均优于对照组,差异均有统计学意义(P<0.05)。手术后,两组患者WBC、降钙素原、CRP水平均升高,但观察组WBC、降钙素原、CRP水平均低于对照组,差异均有统计学意义(P<0.05)。两组患者手术后1 d的S100B蛋白水平均明显升高,手术后3、5 d的S100B蛋白水平逐渐降低,且观察组低于对照组;手术后1 d褪黑素明显降低,手术后3、5 d的褪黑素逐渐升高,观察组高于对照组,差异均有统计学意义(P<0.05)。结论超声引导下髂筋膜间隙阻滞对全�
Objective To investigate the anesthetic effect of different approaches of iliac fascial space block under ultrasound guidance in total hip arthroplasty and its influence on postoperative cognitive function and inflammatory response.Methods Sixty patients with total hip replacement admitted in Anqing Municipal Hospital from March 2020 to March 2021 were selected as the research objects.The patients were divided into observation group and matched group according to the random number table method,with 30 patients in each group.After local anesthesia,all patients were blocked in the iliac fascia space under the guidance of ultrasound.The matched group took a parallel puncture approach,and the observation group took a vertical puncture approach.The anesthesia effect,anesthetic dosage and intraoperative indicators,basic value(T_(1)),vital signs[SpO_(2),heart rate,MAP,diastolic blood pressure and systolic blood pressure]after anesthesia induction(T_(2)),cut the skin(T_(3)),and at the end of surgery(T_(4))were compared between the two groups.the changes of inflammatory factors[WBC,procalcitonin,C-reactive protein(CRP)]at 3 days after operation were compared,the expression level of S100B protein and melatonin in patients at 1 day,3 days and 5 days after operation were compared.Results The excellent rate of anesthesia in the observation group was 100.00%,which was higher than that in the matched group(83.33%),the difference was statistically significant(P<0.05).The number of punctures and injection time in the observation group were higher than those in the matched group,and the dosage of propofol and remifentanil in the observation group were lower than those in the matched group,the differences were statistically significant(P<0.05).At T_(1)~T_(4) time,there were significant differences in SpO_(2),heart rate,MAP,diastolic blood pressure and systolic blood pressure between T_(1) and T_(4) time points in the control group(P<0.05),while there was no statistically significant difference in SpO_(2),heart rate,MAP,diastolic bl
作者
王仕芳
汪卫兵
刘宏亮
WANG Shi-fang;WANG Wei-bing;LIU Hong-liang(Department of Anesthesiology,Anqing Municipal Hospital/Anqing Medical Center of Anhui Medical University,Anqing Anhui 246003,China)
出处
《临床和实验医学杂志》
2023年第8期886-891,共6页
Journal of Clinical and Experimental Medicine
基金
安徽省科学技术厅人口健康专项(编号:202104j07020022)。
关键词
平行穿刺入路
垂直穿刺入路
超声引导
髂筋膜间隙阻滞
全髋关节置换术
认知功能
Parallel puncture approach
Vertical puncture approach
Ultrasound guidance
Iliac fascia space block
Total hip replacement
Cognitive function
