超声引导下高龄患者全髋置换手术临床研究(1)
摘 要 目的：探讨高龄患者全髋置换手术的临床疗效。方法：选取接受全髋置换术治疗的72例80岁以上患者作为研究对象，分为对照组与研究组各36例，对照组给予腰硬联合麻醉，研究组给予超声引导下患侧腰丛神经-坐骨神经阻滞联合氟比洛芬酯麻醉，比较两组神经阻滞效果、不同时间血流动力学变化及不良反应、术后疼痛情况。结果：研究组术后T2、T3、T4、T5、T6时心率、收缩压、舒张压与T1时无明显差异(P>0.05)，但对照组均显著低于T1时的指标(P<0.05)。研究组经感觉神经、运动神经麻醉起效时间低于对照组，麻醉维持时间长于对照组，且麻醉后不良反应发生率及术后12 h、24 h、48 h患者疼痛情况均显著低于对照组(P<0.05)。结论：高龄全髋置换手术患者行超声引导下患侧腰丛-坐骨神经阻滞联合氟比洛芬酯麻醉可维持患者血流动力学稳定，此种手术麻醉起效迅速，作用时间久，安全性较好。
关键词 全髋置换术 超声引导 腰丛-坐骨神经阻滞
中图分类号：R687.42 文献标志码：B 文章编号：1006-1533(2019)05-0053-04
Clinical study of ultrasound-guided total hip arthroplasty in elderly patients
SHANGGUAN Minghua1，2*， LUO Laifeng1，2(1. the Fifth Clinical College of Fujian University of Chinese Medicine， Fujian Sanming 366000， China； 2. Department of Anesthesiology， the Second Hospital of Sanming City， Fujian Sanming 366000， China)
ABSTRACT Objective： To investigate the clinical effect of total hip arthroplasty in elderly patients. Methods： Seventytwo patients over 80 years old undergoing total hip arthroplasty were divided into a control group and a study group with 36 cases each. The control group underwent the combined spinal-epidural anesthesia while the study group was anesthetized by ultrasound guided lumbar plexus nerve block combined with flurbiprofen ester. The effects of nerve block， hemodynamic changes at different time， adverse reactions and postoperative pain were compared between the two groups. Results： There were no significant differences in heart rate， systolic blood pressure (SBP) and diastolic blood pressure (DBP) at T2， T3， T4， T5， T6 after operation compared with those at T1 in the study group (P>0.05)， but those indicators were significantly lower at T2， T3， T4， T5 and T6 than those at T1 in the control group. The onset time for the anesthesia of sensory and motor nerves was shorter， the maintenance time and the duration of anesthesia were longer and the postoperative incidence of adverse reactions and the pain status of the patients at 12， 24 and 48 hours after operation were significantly lower in the study group than the control group(P<0.05). Conclusion： Ultrasound-guided lumbar plexus-sciatic nerve block combined with flurbiprofen ester anesthesia can maintain hemodynamic stability with quick onset and longer duration of anesthesia and good safety in elderly patients with total hip replacement.
KEY WORDS total hip replacement； ultrasound guidance； lumbar plexus-sciatic nerve block
目前，中國人口老龄化日趋严重，老年人群发生骨质疏松性骨折、外伤性骨折等风险显著上升，若骨折后不能及时得到有效治疗，会因长期卧床导致患者发生褥疮、继发性骨不连或肺部严重感染等情况，严重影响其健康与生活质量。骨折后及早行外科手术治疗能促进患者痊愈与肢体功能的恢复，但因大多数高龄患者伴有心血管等系统和慢性阻塞性肺疾病，使其全身性麻醉耐受性差，且存在术后不易脱机、易并发肺部感染等情况[1]。又因高龄患者自身存在骨质疏松或脊柱变形等情况增加穿刺难度，同时又因心血管系统疾病长期口服抗凝药物进行治疗，导致术中椎管内麻醉并发硬膜外血肿的风险显著增加，造成椎管内麻醉失败[2]。研究证实，腰丛-坐骨神经阻滞方式在老年髋部手术患者中具有明显的优势，可降低术后不良反应发生率、稳定其血流动力学、降低术后病死率，尤其适用于高龄患者与全麻、椎管内麻醉禁忌证或失败患者[3-4]。但越来越多的研究发现，在髋关节置换术中单用腰丛-坐骨神经阻滞方式进行麻醉常致手术上切口神经阻滞不全，无法达到手术的需求[5]。氟比洛芬酯注射液(商品名：凯纷)是临床新型的非甾体类靶向镇痛药物，在体内将脂微球作为载体靶向分布至创伤位置，发挥镇痛消炎作用，与传统药物相比，药效持续时间更久，且不会引起胃肠道不良反应[6]。, 百拇医药(上官明化 罗来凤)
关键词 全髋置换术 超声引导 腰丛-坐骨神经阻滞
中图分类号：R687.42 文献标志码：B 文章编号：1006-1533(2019)05-0053-04
Clinical study of ultrasound-guided total hip arthroplasty in elderly patients
SHANGGUAN Minghua1，2*， LUO Laifeng1，2(1. the Fifth Clinical College of Fujian University of Chinese Medicine， Fujian Sanming 366000， China； 2. Department of Anesthesiology， the Second Hospital of Sanming City， Fujian Sanming 366000， China)
ABSTRACT Objective： To investigate the clinical effect of total hip arthroplasty in elderly patients. Methods： Seventytwo patients over 80 years old undergoing total hip arthroplasty were divided into a control group and a study group with 36 cases each. The control group underwent the combined spinal-epidural anesthesia while the study group was anesthetized by ultrasound guided lumbar plexus nerve block combined with flurbiprofen ester. The effects of nerve block， hemodynamic changes at different time， adverse reactions and postoperative pain were compared between the two groups. Results： There were no significant differences in heart rate， systolic blood pressure (SBP) and diastolic blood pressure (DBP) at T2， T3， T4， T5， T6 after operation compared with those at T1 in the study group (P>0.05)， but those indicators were significantly lower at T2， T3， T4， T5 and T6 than those at T1 in the control group. The onset time for the anesthesia of sensory and motor nerves was shorter， the maintenance time and the duration of anesthesia were longer and the postoperative incidence of adverse reactions and the pain status of the patients at 12， 24 and 48 hours after operation were significantly lower in the study group than the control group(P<0.05). Conclusion： Ultrasound-guided lumbar plexus-sciatic nerve block combined with flurbiprofen ester anesthesia can maintain hemodynamic stability with quick onset and longer duration of anesthesia and good safety in elderly patients with total hip replacement.
KEY WORDS total hip replacement； ultrasound guidance； lumbar plexus-sciatic nerve block
目前，中國人口老龄化日趋严重，老年人群发生骨质疏松性骨折、外伤性骨折等风险显著上升，若骨折后不能及时得到有效治疗，会因长期卧床导致患者发生褥疮、继发性骨不连或肺部严重感染等情况，严重影响其健康与生活质量。骨折后及早行外科手术治疗能促进患者痊愈与肢体功能的恢复，但因大多数高龄患者伴有心血管等系统和慢性阻塞性肺疾病，使其全身性麻醉耐受性差，且存在术后不易脱机、易并发肺部感染等情况[1]。又因高龄患者自身存在骨质疏松或脊柱变形等情况增加穿刺难度，同时又因心血管系统疾病长期口服抗凝药物进行治疗，导致术中椎管内麻醉并发硬膜外血肿的风险显著增加，造成椎管内麻醉失败[2]。研究证实，腰丛-坐骨神经阻滞方式在老年髋部手术患者中具有明显的优势，可降低术后不良反应发生率、稳定其血流动力学、降低术后病死率，尤其适用于高龄患者与全麻、椎管内麻醉禁忌证或失败患者[3-4]。但越来越多的研究发现，在髋关节置换术中单用腰丛-坐骨神经阻滞方式进行麻醉常致手术上切口神经阻滞不全，无法达到手术的需求[5]。氟比洛芬酯注射液(商品名：凯纷)是临床新型的非甾体类靶向镇痛药物，在体内将脂微球作为载体靶向分布至创伤位置，发挥镇痛消炎作用，与传统药物相比，药效持续时间更久，且不会引起胃肠道不良反应[6]。, 百拇医药(上官明化 罗来凤)