超声引导腰丛阻滞并右美托咪啶麻醉在高龄髋关节置换术中的应用

目的:评价超声引导下腰丛阻滞复合右美托咪啶和七氟烷全身浅麻醉在高龄髋关节置换患者手术中的应用效果。方法:选取行单侧全髋关节置换术的70岁以上患者38例,随机平分为对照组和试验组。对照组常规气管插管静吸复合全身麻醉,试验组超声引导下腰丛阻滞后复合静注右美托咪啶及吸入七氟烷全身浅麻醉。记录两组手术全程几个重要时段:进入手术室(T0)、气管插管(插入喉罩)即刻(T1)、手术切皮即刻(T2)、手术扩髓时(T3)、缝合切口时(T4)、拔气管导管(喉罩)时(T5)患者心率(HR)和平均动脉压(MAP)以及拔管时间、使用硝酸甘油和多巴胺病例数,统计分析两组间差异。结果:试验组在T1至T5时点的HR和MAP均显著低于对照组(P0.05)。试验组术毕至拔除气管导管(喉罩)的时间显著早于对照组(P0.05)。试验组术中使用硝酸甘油病例数显著少于对照组(2例vs 7例,P0.01)。两组使用多巴胺病例数无统计学差异(P0.05)。结论:超声引导下腰丛阻滞复合右美托咪啶和七氟烷全身浅麻醉对于高龄髋关节置换术是有效、安全的麻醉选择。

Anesthesia Observation on Lumber Plexus Blockade Guided by Ultrasound Combined with Mild Gen-eral Anesthesia with Dexmedetomidine and Sevoflurane Used in Hip Replacement

Objective：To evaluate the effect of lumber plexus blockade guided by ultrasound combined with mild general anesthesia with dexmedetomidine and sevoflurane in hip replacement for elderly patients.Method：38 patients,over 70 years old,who underwent unilateral total hip replacement were selected and divided into two groups randomly.The control group was applied to routine combined intravenous and inhalation anesthesia.The ex-perimental group was subj ected to lumber plexus blockade guided by ultrasound combined with mild general anesthe-sia with dexmedetomidine and sevoflurane.The HR,MAP of each patient at following time points were recorded：people after the room （T0 ）,ETT/LMA insertion（T1 ）,cutting skin and reaming（T2 and T3 ）,incision closing（T4 ）, after the extubation （T5 ）.The total doses of extubation time and the number of cases of using nitroglycerin and do-pamine were analyzed.Results：The comparison of hemodynamic indexes：the experimental group in T1 to T5 point set of HR and MAP were significantly lower than that of the control group at the same time（P〈0.05）.The extuba-tion time of LPB group was earlier（P〈0.05）.7 cases of using nitroglycerin in the control group is higher than that of the experimental group （2 cases）in the operation （P〈0.01）.In the two groups using dopamine cases were no statistical difference （P〉0.05）.Conclusion：The anesthesia method of lumber plexus blockade guided by ultrasound combined with mild general anesthesia with dexmedetomidine and sevoflurane used in hip replacement of elderly pa-tients not only reaches a satisfied anesthetic effect,but also decreases the influence of general body and the occur-rence of respiratory and circulatory system complications.