探究在全髋关节置换术(THA)中全身麻醉、单次髂筋膜阻滞复合应用的效果且对患者术后的影响。

选择116例2018年2月至2021年2月期间于眉山市中医医院接受的经评估适合THA治疗且手术耐受患者，排除合并器质性疾病、凝血功能存在障碍、无法正常交流沟通、合并严重并发症、术前需长期服用镇痛药患者。采用随机数字表法将患者分为对照组(全身麻醉)、研究组(复合应用全身麻醉、单次髂筋膜阻滞)。t检验对比两组药物使用量、术后静息和运动状态下疼痛程度、术后精神状况和认知功能状况、术后心理状态，采用卡方检验对比两组术后恶心呕吐(PONV)和并发症状况。

在用药方面，研究组镇静、镇痛药物包括丙泊酚、舒芬太尼以及瑞芬太尼的用量均比对照组用量更少，差异有统计学意义(t＝33.275、14.483、4.4954，均为P<0.05)。在术后疼痛感方面，不论是静息还是运动状态，研究组的视觉模拟评分(VAS)均明显更低(t＝14.904、5.114，均为P<0.05)。手术前后，两组组内相比简易精神状态检查评分(MMSE)、蒙特利尔认知评估量评分(MoCA)均下降，差异有统计学意义(对照组t＝24.182、29.142，研究组t＝16.045、10.913，均为P<0.05)；术后组间比较，研究组的MMSE评分、MoCA评分更高(t＝3.589、6.606，均为P<0.05)。术前术后组内比较，两组焦虑自评量评分(SAS)、抑郁自评量评分(SDS)都有显著的变化，差异有统计学意义(对照组t＝20.205、14.137，研究组t＝29.438、24.176，均为P<0.05)；其中手术后研究组各项评分均高于对照组(t＝3.145、2.862，均为P<0.05)。研究组PONV发生率(3.4%)低于对照组(15.5%)，差异有统计学意义(χ²＝4.921，P<0.05)；但并发症发生率差异无统计学意义(P>0.05)。

在THA中全身麻醉与单次髂筋膜阻滞的复合应用，不仅可以明显减少用药剂量，起到降低并发症风险的效果，还能舒缓疼痛，有效减少神经损伤，保护患者认知功能。

To explore the effect of combined application of general anaesthesia plus a single dose local iliac fascia block on total hip arthroplasty (THA).

Between February 2018 and February 2021, a total of 116 patients who were suitable for THA treatment and tolerant of the surgery for total hip arthroplasty at Meishan Hospital of Traditional Chinese Medicine were included in this study. Exclusion criteria: patients with other diseases, coagulation dysfunction, difficult to communicate, severe complications and a long history of analgesics. Patients were randomly divided into a control group (general anaesthesia) and a study group (general anaesthesia combined with single dose local iliac fascia block). The dosage of administered anaesthetic drugs, postoperative pain at rest and exercise, as well as mental and cognitive status and psychological status after surgery between the groups were compared by t test. Postoperative nausea and vomiting (PONV) and complications were compared between the two groups by chi square test.

In terms of medication, the dosage of sedative and analgesic drugs administered, including propofol, sufentanil and remifentanil, in the study group was less than that in the control group, with a statistically significant difference (t=33.275, 14.483, 4.4954, all P<0.05). Of the postoperative pain, the visual analogue scale (VAS) score of the study group was significantly lower, and the difference was statistically significant (t=14.904, 5.114, both P<0.05), which showed that the patients in the study group suffered less pain. After surgery, scores of intergroup mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) in both groups decreased than that before surgery, and the differences were statistically significant (control group: t=24.182, 29.142; study group: t=16.045, 10.913; all P<0.05). Postoperative intergroup comparison of MMSE and MoCA scores were higher in the study group (t=3.589, 6.606, both P<0.05). Significant changes in self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores were noticed between the two groups before and after surgery, and the differences were statistically significant (control group: t=20.205, 14.137; study group: t=29.438, 24.176; all P<0.05). The scores of all after surgery observed items in the study group were higher than those in the control group (t=3.145, 2.862, both P<0.05). The study group had a lower incidence of PONV than the control group (3.4% vs 15.5%), with a statistically significant difference (χ²=4.921, P<0.05). Finally, there was no statistically significant difference in the incidence of complication (P>0.05).

The combined applications of general anaesthesia and single dose local iliac fascia block in total hip arthroplasty can not only significantly reduce the drug administration and the risk of complications, but also relieve pain, effectively reduce nerve injury and safeguard the cognitive function of patients.