髂筋膜间隙阻滞复合喉罩全麻在高龄髋关节置换术患者中的应用

目的 回顾比较髂筋膜间隙阻滞(同时阻滞股神经、股外侧皮神经和闭孔神经)复合喉罩全麻与蛛网膜下隙阻滞应用于80岁以上人工股骨头置换术患者(非骨水泥型)的优劣性,探讨适合骨科高龄患者的个体化麻醉方案.方法 回顾性分析98例80岁以上人工股骨头置换术患者的麻醉相关资料,其中髂筋膜间隙阻滞复合喉罩全麻44例(G组),蛛网膜下隙阻滞54例(S组),美国麻醉医师协会(ASA)分级为Ⅱ～Ⅳ级.记录麻醉诱导前以及诱导后5、10、15、20、30 min时的平均动脉压(MAP)和心率(HR),术前及术后即刻、术后6h、术后24 h的疼痛视觉模拟评分(VAS);记录麻黄碱使用次数、合并疾病、不良反应发生情况、手术后住院天数及术前、术后1d睡眠质量;调查手术医生对麻醉方案的满意度.结果 两组术前年龄、性别、体质量指数等差异无统计学意义,G组患者ASAⅣ级例数多于S组(P＜0.05).术后6、24 h时G组VAS评分低于S组(P＜0.01),镇痛效果满意.两组麻醉诱导前及诱导后不同时间点血流动力学差异无统计学意义;G组麻黄碱使用次数多于S组(P＜0.01),S组术后尿潴留的发生率高于G组(P＜0.05).两组手术后住院天数差异无统计学意义(P＞0.05).结论 对高龄髋关节置换患者需根据患者的具体情况选择麻醉方案.在病例选择适当的情况下,髂筋膜阻滞复合喉罩全麻与蛛网膜下隙阻滞相比术后镇痛时间长,安全可行.

Application of iliac fascia block composite laryngeal mask anesthesia in elderly patients udergoing hip arthroplasty

Objective To compare the advantages and disadvantages of iliac fascia block (blocking femoral nerve,lateral femoral cutaneous nerve and obturator nerve simultaneously) composite laryngeal mask anesthesia with spinal anesthesia in elderly patients (≥80 years old) undergoing artificial femoral head replacement (not bone cement type),so as to explore the individualized anesthesia scheme for orthopedic elderly patients.Methods We retrospectively analyzed the anesthesia related data of 98 elderly patients (≥80 years old) undergoing artificial femoral head replacement,including 44 cases with iliac fascia block composite laryngeal mask anesthesia in group G and 54 cases with spinal anesthesia in group S,with the American Association of Anesthesiologists (ASA) grade being Ⅱ-Ⅳ.Mean arterial pressure (MAP) and heart rate (HR) of patients were recorded before anesthesia induction,and after anesthesia induction for 5,10,15,20,and 30 min.Visual Analogue Scale (VAS) score was recorded before surgery,immediately after surgery,and at 6 h,24 h after surgery.The number of methamphetamine used,complications,incidence of side effects,length of hospital stay,and sleep quality before and 1 day after operation were recorded,and surgeon's satisfaction with the anesthesia scheme was investigated.Results There were no significant differences in age,gender or body mass index of patients between the two groups.The number of ASA Ⅳ patients in the group G was significantly larger than that in the group S (P＜0.05).VAS score in the group G was significantly lower than that in the group S (P＜0.01) at 6 h and 24 h after surgery,and the analgesic effect was satisfactory.There was no significant difference in hemodynamics between the two groups before and after anesthesia induction.The number of methamphetamine used in the group G was significantly higher than that in the group S (P＜0.01).Incidence of postoperative urinary retention in the group S was significantly higher than that in the group G (P＜0.05).There was no significant difference in length of hospital stay after surgery between the two groups (P＞0.05).Conclusion Individualized anesthesia scheme for elderly patients undergoing hip arthroplasty should be considered.In selected patients,iliac fascia blockade composite laryngeal mask anesthesia has longer time of postoperative analgesia,and is safer and more feasible compared with spinal anesthesia.