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中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (02) : 131 -136. doi: 10.3877/cma.j.issn.1674-134X.2020.02.001

所属专题: 文献

临床论著

腰椎旁神经阻滞联合浅全麻在髋关节置换术的效果
姚曙东1, 贾伟1,()   
  1. 1. 435000 黄石,鄂东医疗集团黄石市中心医院麻醉科
  • 收稿日期:2018-06-08 出版日期:2020-04-01
  • 通信作者: 贾伟

Effects of paravertebral nerve block combined with shallow general anesthesia on patients undergoing hip replacement

Shudong Yao1, Wei Jia1,()   

  1. 1. Department of Anesthesiology, Huangshi Central Hospital of Edong Medical Group, Huangshi 435000, China
  • Received:2018-06-08 Published:2020-04-01
  • Corresponding author: Wei Jia
  • About author:
    Corresponding author: Jia Wei, Email:
引用本文:

姚曙东, 贾伟. 腰椎旁神经阻滞联合浅全麻在髋关节置换术的效果[J/OL]. 中华关节外科杂志(电子版), 2020, 14(02): 131-136.

Shudong Yao, Wei Jia. Effects of paravertebral nerve block combined with shallow general anesthesia on patients undergoing hip replacement[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(02): 131-136.

目的

探讨腰椎旁神经阻滞联合浅全麻对髋关节置换术(HR)患者麻醉效果的影响。

方法

选取2016年3月至2018年3月鄂东医疗集团黄石市中心医院收治的HR患者100例,纳入无精神病病史、无沟通交流障碍、签署知情同意书、年龄18~70岁、无药物过敏者,排除拒绝或中途退出本次研究及有影响本研究的治疗史或疾病者。依据随机数字表法分为腰阻+全麻组和单全组,每组50例,单全组给予全麻,腰阻+全麻组在此基础上给予腰椎旁神经阻滞。比较两组平均动脉压(MAP)、心率(HR)、肿瘤坏死因子α(TNF-α)、白介素-6(IL-6)、纤维蛋白原(FIB)、D-二聚体(DD)、全麻药物用量、镇痛优良率、不良反应发生率和呼之睁眼、呼之握拳、拔管、苏醒时间。其中计数资料采用卡方检验,计量资料采用独立样本t检验,各组内的时间差异采用重复测量方差分析,进一步两两比较用LSD-t检验。

结果

腰阻+全麻组麻醉后10 min(T1)、髋关节置换时(T2)、术毕(T3)的MAP、HR、TNF-α、IL-6、FIB、DD明显低于单全组,差异有统计学意义(t=8.422、9.782、7.242、5.762、7.572、5.242、4.913、5.995、5.206、5.908、5.154、5.658、4.200、9.363、3.675、3.332、8.642、4.022,均为P<0.001);腰滞组镇痛优良率明显高于全麻组,差异有统计学意义(χ2=6.061,P<0.05);腰滞组不良反应发生率、全麻药物用量和呼之睁眼、呼之握拳、拔管、苏醒时间明显低于全麻组,差异有统计学意义(χ2=6.250,P<0.05;t=9.299、8.093、13.397、28.452、14.349,均为P<0.001)。

结论

腰椎旁神经阻滞联合浅全麻可有效提高HR患者镇痛效果及降低炎性反应,有利于减少全麻药物用量和不良反应,且可有效促进患者苏醒康复,值得临床作进一步推广。

Objective

To observe the effect of paravertebral nerve block combined with shallow general anesthesia on the anesthesia effect in patients undergoing hip replacement (HR).

Methods

One hundred patients undergoing HR were selected from March 2016 to March 2018 in Huangshi Central Hospital of Edong Medical Group, those who informed consent, 18-70 years old and with no drug allergy, psychosis history or communication barriers, were included. Those who refused or withdrawed from the study and those who had treatment history or diseases affecting the study were excluded. According to the method of random number table, the patients were divided into lumbar block & general anesthesia group and single general anesthesia group, 50 cases in each group. The single general anesthesia group were given general anesthesia, and the lumbar block & general anesthesia group were combined lumbar paravertebral nerve block with general anesthesia. The chi-square test was used for counting data, the independent sample t test was used for measurement data, the repeated measurement analysis of variance was used to analyze the time difference within each group, the LSD-t test was used for those with statistical difference, and the mean arterial pressure (MAP), heart rate (HR), fibrinogen (FIB), D-dimer (DD), tumor necrosis factor alpha (TNF-α), interleukin -6 (IL-6), dosage of drugs, excellent rate of analgesia, incidence of adverse reactions and the time of opening eyes, clenching, extubating, awakening were compared between the two groups.

Results

The MAP、HR、TNF-α、IL-6、FIB、DD in the lumbar block & general anesthesia group were significantly lower than those in the single general group when at 10min after anesthesia (T1), at the time of hip replacement (T2), at the end of the operation (T3), the difference is statistically significant (t=8.422, 9.782, 7.242, 5.762, 7.572, 5.242, 4.913, 5.995, 5.206, 5.908, 5.154, 5.658, 4.200, 9.363, 3.675, 3.332, 8.642, 4.022, all P <0.001). The excellent rate of analgesia in the lumbar block & general anesthesia group was higher than that in the single general group, the difference is statistically significant (χ2=6.061, P<0.05). The dosage of drugs, the incidence of adverse reactions and the time of opening eyes, clenching, extubating, awakening in the lumbar block & general anesthesia group were significantly lower than those in the single general group, the difference is statistically significant (χ2=6.250, P<0.05; t=9.299, 8.093, 13.397, 28.452, 14.349, all P<0.001).

Conclusion

Lumbar paravertebral nerve block combined with shallow general anesthesia can effectively improve the analgesic effect of HR patients and relieve the stress response of inflammation, it is beneficial to reduce the dosage of drugs and adverse reactions, and can effectively promote the patient’s recovery.

表1 两组一般资料比较
表2 两组各时间点的MAP、HR比较(±s)
表3 两组TNF-α、IL-6水平比较[(ng/L),±s]
表4 两组FIB、DD水平比较(±s)
表5 两组镇痛效果比较[例(%)]
表6 两组不良反应比较[例(%)]
表7 两组苏醒康复质量比较[min,(±s)]
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