摘要
目的探讨0.35%,0.30%,0.25%罗哌卡因腰丛神经阻滞加全身麻醉对行髋关节置换术高龄患者麻醉效果及安全性的影响。方法前瞻性选取上海市第六人民医院2016年1月至2018年12月收治行髋关节置换术高龄患者共280例,以随机抽签法分为对照组(70例)、试验组1(70例)、试验组2(70例)及试验组3(70例),分别采用全身麻醉、0.35%,0.30%,0.25%罗哌卡因腰丛神经阻滞加全身麻醉方案。比较四组气管插管时(T0)、手术切皮时(T1)、缝合切口时(T2)、进入麻醉苏醒室后30 min(T3)时间点,血流动力学指标水平,拔管时间,下床活动时间,住院时间,麻醉药物用量,术后2 h、12 h、24 h、48 h疼痛视觉模拟(VAS)评分,术后认知功能障碍(POCD)和术后瞻望(POD)发生率。结果试验组3的T1、T2及T3时间点心率和动脉压水平均显著高于试验组1、试验组2及对照组(P <0.05);试验组1、2及3拔管时间、下床活动时间及住院时间均显著少于对照组(P <0.05);试验组1、2及3舒芬太尼用量和术后24 h自控镇痛(PCA)用量均显著少于对照组(P <0.05);试验组1、2及3术后2 h、12 h、24 h及48 h疼痛VAS评分均显著低于对照组(P <0.05);同时试验组1、2及3术后POCD和POD发生率显著低于对照组(P <0.05);试验组1、2及3组间拔管时间、下床活动时间、住院时间、麻醉药物用量、疼痛VAS评分、POCD及POD发生率比较差异无显著性(P>0.05)。结论罗哌卡因腰丛神经阻滞加全身麻醉用于行髋关节置换术高龄患者可有效提高术中血流动力学稳定性,加快康复进程,提高镇痛效果,并有助于减轻认知功能损伤,同时应用0.25%罗哌卡因者的血流动力学稳定性优于应用0.35%、0.30%罗哌卡因者,0.25%罗哌卡因更具临床应用价值。
Objective To investigate the influence of lumbar plexus block for ropivacaine as 0.35%,0.30%,0.25% plus general anesthesia on anesthesia effect and safety of elderly patients undergoing hip replacement.Methods 140 elderly patients undergoing hip replacement were chosen in the period from January 2016 to December 2018 in our hospital and randomly divided into both groups including control group(70 patients) with general anesthesia,experiment 1 group( 70 patients) with lumbar plexus block for ropivacaine as 0.35% plus general anesthesia,experiment 2 group( 70 patients) with lumbar plexus block for ropivacaine as 0.30% plus general anesthesia and experiment 3 group( 70 patients) with lumbar plexus block for ropivacaine as 0.25% plus general anesthesia;and the levels of hemodynamic index at the time of tracheal intubation( T0),surgical incision( T1),suture incision( T2),30 min after entering the anesthesia recovery chamber( T3),extubation time,time of getting out of bed,hospital staying time,dosage of anesthetics,2 h,12 h,24 h and 48 h pain VAS score,incidence of POCD and POD of 4 groups were compared.Results The levels of heart rate and arterial pressure at time points of T1,T2 and T3 of experiment 3 group were significantly higher than control group,experiment 1 group and experiment 2 group( P < 0.05).The extubation time,time of getting out of bed and hospital staying time of experiment 1 group,experiment 2 group and experiment 3 group were significantly shorter than control group( P < 0.05).The sufentanil dosage and PCA dosage in 24 h after operation of experiment 1 group,experiment 2 group and experiment 3 group were significantly less than control group( P < 0.05).The pain VAS score in 2 h,12 h,24 h and 48 h after operation of experiment 1 group,experiment 2 group and experiment 3 group were significantly lower than control group( P < 0.05).The incidence of POCD and POD of experiment 1 group,experiment 2 group and experiment 3 group were significantly lower than control group( P < 0.05).There was no significant difference in the extubation time,time of getting out of bed,hospital staying time,dosage of anesthetics,pain VAS score,incidence of POCD and POD among experiment 1 group,experiment 2 group and experiment 2 group( P < 0.05) Conclusion Lumbar plexus block for ropivacaine plus general anesthesia on elderly patients undergoing hip replacement can efficiently higher intraoperative hemodynamic stability,speed up rehabilitation process,improve analgesic effect and be helpful to alleviate cognitive impairment and ropivacaine as 0.25% possess the better hemodynamic stability compared with ropivacaine as 0.30% and 0.35%.
作者
何喜欢
黄丁丁
翁浩
HE Xi-huan;HUANG Ding-ding;WENG Hao(Department of Anesthesiology, Southern Hospital of Shanghai Sixth People's Hospital, Shanghai 201400, China)
出处
《临床和实验医学杂志》
2019年第12期1336-1339,共4页
Journal of Clinical and Experimental Medicine
基金
上海市卫生和计划生育委员会科研课题(编号:201440571)
