超声下PENG辅助椎管内麻醉在老年患者THA手术中的应用

doi:10.7517/issn.1674-0475.220325

摘要/Abstract

摘要： 本研究探讨超声下髋关节囊周围神经（PENG）阻滞辅助椎管内麻醉在老年全髋关节置换术（THA）中的应用价值。选取180例拟全麻下实施THA手术的60岁以上患者作为研究对象，进行随机分组试验，其中90例患者作为研究组（麻醉方法：PENG+椎管内麻醉），另外90例患者作为对照组（麻醉方法：椎管内麻醉）。研究组患者的椎管内麻醉操作时间、麻醉起效时间、自主呼吸恢复时间均低于对照组（P<0.05）；研究组在切皮时、手术30 min的平均动脉压（MAP）值均高于对照组，研究组在术后10 min的MAP值低于对照组（P<0.05）；术后10 min时，研究组的心率（HR）值低于对照组，切皮时的HR值高于对照组（P<0.05）；研究组在手术后10 min的凝血酶原时间（PT）、活化部分凝血酶时间（APTT）值均高于对照组，纤维蛋白原（FIB）、血清P物质及皮质醇（Cor）均低于对照组（P<0.05）；研究组整体对麻醉效果的满意度高于对照组，并发症率低于对照组（P<0.05）。老年THA患者采用超声下实施PENG辅助椎管内麻醉较单纯使用椎管内麻醉具有更令患者满意的麻醉效果，同时对患者的血流动力学、凝血功能及应激反应程度影响更小。

关键词: 超声, 周围神经阻滞, 椎管内麻醉, 老年, 全髋关节置换术

Abstract: This study investigated the application value of peripheral hip nerve block (PENG) under ultrasound to assist spinal anesthesia in elderly total hip arthroplasty (THA). 180 patients over 60 years old were to undergo THA surgery under general anesthesia were selected as the research objects, and a randomized trial was conducted, of which 90 patients were selected as the research group (anesthesia method:PENG+spinal anesthesia), and the other 90 patients were selected as the control group (anesthesia method:spinal anesthesia). The operation time of spinal anesthesia, the onset time of anesthesia and the recovery time of spontaneous breathing of the patients in the research group were all lower than those in the control group (P<0.05). The mean artery pressure (MAP) value of the research group at the time of skin incision and 30 min after surgery was higher than that of the control group, the MAP value of the study group at 10 min after surgery was lower than that of the control group(P<0.05). The heart rate(HR) value of the study group was lower than that of the control group at 10 min after surgery, while at the time of skin incision the HR value was higher than that of the control group (P<0.05). The prothrombin time (PT) and activeated partial thromboplasting time (APTT) values of the study group were both higher than those of the control group 10 min after the operation, and the fibrinogen (FIB), substance P and cortisol (Cor) were lower than those of the control group (P<0.05). The overall satisfaction of anesthesia effect in study group was higher than that in control group, and the complication rate was lower than that in control group (P<0.05). Compared with the simple use of spinal anesthesia, the use of PENG-assisted spinal anesthesia under ultrasound in elderly THA patients has a more satisfactory anesthesia effect, and has less impact on the patient's hemodynamics, coagulation function and stress response.

Key words: ultrasound, peripheral nerve block, intraspinal anesthesia, elderly, total hip replacement

宋庆迎, 种朋贵. 超声下PENG辅助椎管内麻醉在老年患者THA手术中的应用[J]. 影像科学与光化学, 2022, 40(5): 1231-1235.

SONG Qingying, ZHONG Penggui. Application of PENG-assisted Spinal Anesthesia under Ultrasound in Elderly Patients with THA Surgery[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(5): 1231-1235.

参考文献

[1] 廖家涛, 黎笔熙, 殷国江, 等. 超声引导下髂筋膜间隙阻滞对老年髋关节置换手术患者围手术期镇痛效果的临床研究[J]. 华南国防医学杂志, 2020, 34(9):635-639.
[2] 项明琼, 樊玉花, 陈赛金, 等. 不同指导方法对椎管内麻醉体位摆放的影响[J]. 临床和实验医学杂志, 2015, 14(7):605-608.
[3] 杨曙光, 陶红, 陈超, 等. 超声引导髋关节囊周围神经阻滞在老年髋部骨折病人术前镇痛中的应用[J]. 骨科, 2020, 11(2):140-142.
[4] 谢颖超, 王美容, 李志鹏, 等. 超声引导下髋关节囊周神经丛阻滞对股骨颈骨折老年患者摆放侧卧位时疼痛的影响[J]. 临床麻醉学杂志, 2020, 36(8):754-758.
[5] 余承易, 吴天添. 超声引导下腰骶丛神经阻滞联合全身麻醉用于髋关节置换术60例[J]. 医药导报, 2020, 39(5):658-661.
[6] 袁岚, 唐炜, 王剑, 等. 经皮穴位电刺激对全麻髋关节置换术老年患者控制性降压期间脑氧代谢的影响[J]. 针刺研究, 2014, 39(1):7-11, 19.
[7] 季惠, 李辉, 季晓燕, 等. 超声引导下罗哌卡因腹横肌平面阻滞联合全凭静脉麻醉对腹部手术患者术中循环稳定性和术后疼痛程度的影响[J]. 中国医师杂志, 2021, 23(10):1552-1555.
[8] Qu B, Chen L Y, Zhang Y L, et al. Correction to:Landmark-guided versus modified ultrasound-assisted paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures:A randomized controlled trial[J]. BMC Anesthesiology, 2020, 20(1):268.
[9] 陈娟. 超声引导下腘窝上和大转子下外侧入路坐骨神经阻滞应用于老年全膝关节置换术后镇痛的效果比较[J]. 蚌埠医学院学报, 2020, 45(9):1180-1183.
[10] Gungor I, Gunaydin B, Oktar S O, et al. A real-time anatomy dentification via tool based on artificial ntelligence for ultrasound-guided peripheral nerve block procedures:An accuracy study[J]. Journal of Anesthesia, 2021, 35(4):591-594.
[11] 秦洪猛, 王星, 司海超, 等. 麻醉方式对髋关节置换患者术后谵妄和镇痛效果的影响[J]. 中国矫形外科杂志, 2020, 28(11):903-908.
[12] He J, Zhang L, Li D L, et al. Ultrasound-guided pudendal nerve block combined with propofol deep sedation versus spinal anesthesia for hemorrhoidectomy:A prospective randomized study[J]. Pain Research & Management, 2021, 2021(12):6644262.
[13] 崔明珠, 曹颖莉, 苏靖心, 等. 髋关节囊周围神经阻滞用于蛛网膜下腔阻滞髋关节置换术老年患者镇痛的效果[J]. 中华麻醉学杂志, 2020, 40(2):199-202.
[14] 程龙, 郑少强, 陈晨, 等. 髋关节囊周围神经阻滞在髋关节置换术中的应用[J]. 中国医刊, 2021, 56(5):578-580.
[15] 单涛, 韩流, 葛德高, 等. 超声引导下髋关节囊周围神经阻滞联合椎管内麻醉在老年患者全髋关节置换术中的应用[J]. 临床麻醉学杂志, 2021, 37(5):458-461.