全麻联合腰丛—坐骨神经阻滞在老年髋关节置换术中的应用效果

陈凤萍

[摘要] 目的 观察全麻联合腰丛-坐骨神经阻滞在老年髋关节置换术中的临床疗效。方法 将70例老年髋关节置换术患者随机分成试验组和对照组，对照组采用气管插管静脉全麻，而试验组采用全麻联合腰丛-坐骨神经阻滞，比较两组术中麻醉药用量及拔管前后生命体征变化。 结果 试验组患者的麻醉药物丙泊酚、芬太尼、维库溴铵、瑞芬太尼少于对照组（P<0.05）；试验组苏醒及拔管时间缩短，疼痛、躁动发生率减少（P<0.05）；试验组生命体征较对照组更为稳定（P<0.05）。 结论 全麻联合腰丛-坐骨神经阻滞用于老年髋关节置换手术，用药少，能更好地维持患者的症状。

[关键词] 全麻；腰丛-坐骨神经阻滞；髋关节置换术；临床研究

[中图分类号] R614.2 [文献标识码] B [文章编号] 1673-9701（2017）21-0093-03

Application effect of general anesthesia combined with lumbar plexus-sciatic nerve block in elderly hip replacement

CHEN Fengping

Department of Anesthesiology， Yulin First People's Hospital in Guangxi Zhuang Autonomous Region， Yulin 537000， China

[Abstract] Objective To observe the clinical effect of general anesthesia combined with lumbar plexus-sciatic nerve block in elderly hip replacement. Methods A total of 70 elderly patients with hip replacement were randomly divided into the experimental group and the control group. The control group was given tracheal intubation intravenous anesthesia， while the experimental group was given general anesthesia combined with lumbar plexus-sciatic nerve block. The intraoperative anesthetic dosage and changes in vital signs before and after extubation between two groups were compared. Results The propofol， fentanyl， vecuronium and remifentanil were less in the experimental group than the control group（P<0.05）； the revival and extubation time in the experimental group were shorter， and the incidence rates of pain and agitation were reduced（P<0.05）； the vital signs in the experimental group were more stable than that in the control group（P<0.05）. Conclusion General anesthesia combined with lumbar plexus-sciatic nerve block method for elderly patients with hip replacement has less medication， which can better maintain the symptoms of patients.

[Key words] General anesthesia； Lumbar plexus-sciatic nerve block； Hip replacement； Clinical study

人工髖关节置换术属于人工关节置换手术的一种，多用于老年患者，而老年患者因年龄的增长，身体机能逐渐下降，导致老年髋关节置换术中的麻醉安全等问题备受重视[1-2]。全麻一直是人工髋关节置换术的标准麻醉方法，但其引起的并发症会对患者造成不利影响，也使其临床应用受到了一定限制，全麻联合腰丛-坐骨神经阻滞当前受到了较多的关注，我院对进行老年髋关节置换术的70例患者分别采取了普通全麻和全麻联合腰丛-坐骨神经阻滞，旨在探讨出老年髋关节置换手术更安全的麻醉方法，为以后的临床诊断做参考。

1 资料与方法

1.1一般资料

选取2014年6月～2016年6月于我院接受髋关节置换术的老年患者70例，根据美国麻醉医师协会（ASA），所有患者皆为创伤型全髋关节置换术，均处于1～3级[3]。将患者随机分为试验组和对照组，各35例。试验组采用全麻联合腰丛–坐骨神经阻滞进行麻醉，合并糖尿病8例，合并慢支6例，合并心血管疾病15例。……