许克路, 沈勤, 柏耀林, 冯传江. 腰丛阻滞复合不同麻醉深度喉罩全麻在老年THA围手术期的应用[J]. 蚌埠医学院学报, 2021, 46(8): 1017-1022. DOI: 10.13898/j.cnki.issn.1000-2200.2021.08.008
    引用本文: 许克路, 沈勤, 柏耀林, 冯传江. 腰丛阻滞复合不同麻醉深度喉罩全麻在老年THA围手术期的应用[J]. 蚌埠医学院学报, 2021, 46(8): 1017-1022. DOI: 10.13898/j.cnki.issn.1000-2200.2021.08.008
    XU Ke-lu, SHEN Qin, BAI Yao-lin, FENG Chuan-jiang. Application value of lumbar plexus block combined with laryngeal mask general anaesthesia with different depths of anaesthesia in perioperative period of THA in elderly patients[J]. Journal of Bengbu Medical College, 2021, 46(8): 1017-1022. DOI: 10.13898/j.cnki.issn.1000-2200.2021.08.008
    Citation: XU Ke-lu, SHEN Qin, BAI Yao-lin, FENG Chuan-jiang. Application value of lumbar plexus block combined with laryngeal mask general anaesthesia with different depths of anaesthesia in perioperative period of THA in elderly patients[J]. Journal of Bengbu Medical College, 2021, 46(8): 1017-1022. DOI: 10.13898/j.cnki.issn.1000-2200.2021.08.008

    腰丛阻滞复合不同麻醉深度喉罩全麻在老年THA围手术期的应用

    Application value of lumbar plexus block combined with laryngeal mask general anaesthesia with different depths of anaesthesia in perioperative period of THA in elderly patients

    • 摘要:
      目的探讨B超引导腰丛阻滞(“三叶草”法)复合脑电双频指数(BIS)监测不同麻醉深度的喉罩全麻在老年全髋关节置换术(THA)病人围手术期的应用效果。
      方法选取老年THA病人82例,依据随机数字表法分为A组与B组,各41例。B超引导腰丛阻滞(“三叶草”法)基础上,A组将喉罩全麻时BIS值维持于55~65,B组将BIS值维持于40~50。统计2组术前及术后6、12、24、48 h静息痛与运动疼痛评分(VAS)、围手术期应激水平心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、术后自控镇痛情况(术后首次应用时间、使用次数、有效按压率、舒芬太尼用量)、术后恢复情况(苏醒时间、拔管时间、定向力恢复时间)、术前及术后1、3、7 d认知功能(MMSE)评分、肺部感染情况、不良反应发生率。
      结果疼痛及自控镇痛情况:与术前比较,术后6 h、12 h、24 h、48 h 2组静息VAS、运动VAS评分均降低(P < 0.05),组间比较差异无统计学意义(P>0.05);2组静脉自控镇痛术后首次应用时间、术后0~24 h、24~48 h使用次数、有效按压率、舒芬太尼用量比较差异均无统计学意义(P>0.05)。手术应激:T1、T2、T3、T4时刻2组RR、HR、MAP水平均低于T0时刻(P < 0.05),但组间比较差异无统计学意义(P>0.05)。术后恢复:术后统计结果显示,A组苏醒时间、拔管时间、定向力恢复时间均短于B组(P < 0.01)。认知功能:与术前比较,术后1 d 2组MMSE评分降低(P < 0.05),术后1 d、3 d、7 d A组MMSE评分与B组间差异无统计学意义(P>0.05)。肺部感染及麻醉不良反应:术后观察统计发现,2组肺部感染、不良反应发生率比较差异均无统计学意义(P>0.05)。
      结论“三叶草”法B超引导腰丛阻滞的同时复合实施BIS监测浅度喉罩全麻可达到与深度喉罩全麻等同的麻醉镇痛效果,不增加认知功能损伤、肺部感染、麻醉不良反应发生风险,且有利于病人术后恢复,临床可根据实际情况酌情应用。

       

      Abstract:
      ObjectiveTo investigate the effects of B-ultrasound-guided lumbar plexus block("clover" method) combined with bispectral index(BIS) in monitoring the laryngeal mask general anesthesia with different depths of anesthesia in the perioperative period of elderly total hip arthroplasty(THA) patients.
      MethodsA total of 82 elderly patients treated with THA were divided into the group A and group B according to the random number table method(41 cases in each group).On the basis of ultrasound-guided lumbar plexus block("clover" method), the BIS value in group A and group B were maintained at 55-65 and 40-50, respectively.The resting pain score and movement pain score(VAS) before and after 6, 12, 24 and 48 h of operation, perioperative stress levelsincluding the heart rate(HR), respiratory rate(RR) and mean arterial pressure(MAP), self-control analgesia after surgery(including the postoperative first application time, times of use, effective compression rate and sufentanil dosage), postoperative recovery(including waking time, extubation time and directional force recovery time), preoperative and intraoperative cognitive function(MMSE) score before and after 1, 3 and 7 days of operation in two groups were counted.
      ResultsFor pain and self-controlled analgesia, the resting VAS and movement VAS scores in two groups after 6, 12, 24 and 48 h of surgery were decreased compared with before operation, and the difference of which between two groups was not statistically significant(P>0.05).The differences of the first application time, times of use after 0-24 h and 24-48 h of operation, effective press rate and sufentanil dosage between two groups were not statistically significant(P>0.05).For surgical stress, the levels of RR, HR and MAP in two groups at T1, T2, T3 and T4 were lower than those at T0(P < 0.05), but the difference of which between two groups was not statistically significant(P>0.05).For postoperative recovery, the reults of postoperative statistical results showed that the recovery time, extubation time and orientation recovery time in group A were shorter than those in group B(P < 0.01).For cognitive function, the MMSE scores in two groups decreased at 1 day after operation compared with before opertaion(P < 0.05).The differences of the MMSE scores after 1, 3 and 7days of operation between two groups were not statistically significant(P>0.05).For pulmonary infection and adverse reactions of anesthesia, the differences of the incidence rates of lung infection and adverse reactions between two groups were not statistically significant after operation(P>0.05).
      ConclusionsThe "clover" method B-ultrasound-guided lumbar plexus block combined with implementation of BIS monitoring shallow laryngeal mask general anesthesia can achieve the same anesthetic analgesia effect as deep laryngeal mask general anesthesia.It does not increase the risk of cognitive impairment, pulmonary infection and adverse reactions to anesthesia, and is conducive to postoperative recovery of patients.It can be used appropriately according to the actual situation.

       

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